Type 1 Diabetes is a Risk Factor for Vitiligo Development, Study Reports

Type 1 (T1) diabetes mellitus is considered a risk factor for the development of vitiligo, according to findings from a study published in Skin Research and Technology.¹

Furthermore, application of T1 diabetes-related measures could potentially provide novel ways to prevent or address vitiligo, according to researchers Hu et al.

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Background and Methods

Historically, numerous observational studies have reported the co-manifestations of vitiligo and dysglycemic diseases such as T1 and Type 2 (T2) diabetes. A 2019 study published in the Journal of the American Academy of Dermatology reported that while T2 diabetes and vitiligo can occur concomitantly, the exact associations related to the pathogenesis could not be confirmed.²

Another study (Tekielak, 2023), reported that while vitiligo and insulin resistance could be linked, there remained a further need for research into the pathogenesis of the conditions when comorbid.³

Authors of the present study noted that while these studies have added value and context to the relationship between pigmentation and disorders of a dysglycemic nature, they have primarily been observational in nature. Thus, they presented a Mendelian randomization analysis assessing the causal relationship between vitiligo and T1 or T2 diabetes. They also examined other pivotal glycemic profile factors such as fasting plasma glucose and HbA1c levels.

Their research involved 3 main Mendelian randomization approaches: univariate to assess the impact of blood glucose and diabetes characteristics on vitiligo, inverse to explore how vitiligo might influence dysglycemia and diabetes onset, and multivariable to analyze the independent effects of HbA1c, T1 diabetes, and other factors on vitiligo prognosis.

Data for this study were sourced from publicly available genome-wide association studies. The study utilized data from the IEU online database for HbA1c and vitiligo, the European Bioinformatics Institute for fasting blood glucose, and FinnGen for T1 and T2 diabetes. The analysis involved 42 single nucleotide polymorphisms, with 32 retained after data harmonization.

Findings

The univariate analysis assessed the effects of fasting blood glucose, HbA1c, T1 diabetes, and T2 diabetes on vitiligo. The primary method used was inverse variance weighting, with no significant heterogeneity detected. Results showed a significant causal link between T1 diabetes mellitus and vitiligo (p = 0.018).

The study then employed a multivariate model to explore the combined effects of HbA1c, T1 diabetes, and vitiligo. The analysis confirmed a significant causal relationship between T1 diabetes and vitiligo (p = 0.016), consistent with the univariate results.

To examine if vitiligo could influence blood glucose levels or diabetes, researchers also conducted a reverse analysis. This approach found no significant causal associations between vitiligo and any of the blood glucose measures or diabetes types. The results indicated no reverse causation, reinforcing that T1 diabetes mellitus is causally related to vitiligo, but not vice versa.

Conclusions

"Our study has revealed a positive causal relationship between T1DM and the incidence of vitiligo, while no causal link was found between glycemic traits, and the development of vitiligo," according to Hu et al. "Conversely, Reverse MR analysis indicates that the onset of vitiligo does not affect the incidence of diabetes or alterations in glycemic characteristics."

Potential limitations of the study, as noted by researchers, include its exclusively European patient cohort and the exclusion of data related to insulin resistance, as the sample size in this regard was not large enough to conduct Mendelian randomization analyses.

"The results of MR Studies have shown that T1DM is a potential risk factor for the development of vitiligo, and MR results have provided genetic evidence for a causal relationship between T1DM and vitiligo," Hu et al wrote.

Moving forward, researchers noted that therapies and measures used for treating T1 diabetes might offer potential benefits for preventing or treating vitiligo, and it may be worth exploring existing diabetes treatments or management strategies for their efficacy in addressing vitiligo.

References

1. Hu S, Che Y, Cai J, Chen S, Gao R, Huang X. Diabetes, glycemic profile and risk of vitiligo: A Mendelian randomization study. Skin Res Technol. Published online July 11, 2024. https://doi.org/10.1111/srt.13787
2. Chang HC, Lin MH, Huang YC, Hou TY. The association between vitiligo and diabetes mellitus: A systematic review and meta-analysis. J Am Acad Dermatol. 2019; 81(6): 1442-1445.
3. Tekielak A, Pietrauszka K, Miziołek B, Bergler-Czop B. Vitiligo and insulin resistance as a component of metabolic syndrome: an analysis. Postepy Dermatol Alergol. 2023;40(4):529-533. doi:10.5114/ada.2023.126871