A retrospective, non-interventional, electronic medical record based real world data analysis in patients suffering from pruritus in type 2 diabetes mellitus

Sanjay Kalra, Asit Mittal, Kapil Vyas, Roheet Mohan Rathod, Rahul Rathod, Seema Vikas Bhagat, Amey Mane, Dinesh Kumar Hawelia, Utsa Basu, Snehal Shah


Background: There is limited data highlighting the association of pruritus with Type 2 Diabetes Mellitus (T2DM). This was the first Electronic Medical Record (EMR) based real-world observational study on the demographics, clinical characteristics, associated risk factors and treatment(s) of pruritus in T2DM in India.

Methods: EMR data of patients was retrospectively analysed with a baseline (V1) visit and two or more follow-up visits between June 2014-December 2019.

Results: Majority of patients were 40-64 years old and mainly females (57%). Body mass index and co-morbidity data indicated a trend of obesity and hypertension. Observed HbA1c values were high (mean value of 9%). Majority of the patients were on hydroxyzine. Miconazole, fluconazole and corticosteroids were prescribed in 40% patients. Correlation between HbA1c levels with clinical pruritus was noted.

Conclusions: Management of glycaemia along with timely dermatological intervention is needed for pruritus relief in T2DM, the use of antihistamines; in particular, hydroxyzine, should be further evaluated.


Antihistamines, Blood glucose levels, HbA1c, Hypertension, Pruritus, Type 2 diabetes mellitus

Full Text:



Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14:88-98.

Williams R, Colagiuri S, Chan J, Gregg E, Ke C, Lim L-L, et al. IDF Atlas 9th Edition. 2019.

Grundmann S, Ständer S. Chronic pruritus: clinics and treatment. Annals of dermatology. 2011;23(1):1-11.

DermNet NZ. Skin problems associated with diabetes mellitus. Available at: Accessed on January 21, 2020.

Chaplin S. New guidelines on managing generalised pruritus. Prescriber. 2018;29:35-8.

Weisshaar E, Szepietowski JC, Dalgard F, Garcovich S, Gieler U, Gimenez-Arnau A, et al. European S2k Guideline on Chronic Pruritus In cooperation with the European Dermatology Forum (EDF) and the European Academy of Dermatology and Venereology (EADV). Acta Derm Venereol. 2019;99:469-505.

Weisshaar E, Fleischer Jr AB, Bernhard JD, Cropley TG. Pruritus and dysesthesia. In: Bolognia JL, Jorizzo JL, Schaffer JV eds. Dermatology, 3rd ed. Philadelphia: Elsevier Saunders. 2012;111-20.

Babakinejad P, Walton S. Diabetes and pruritus. Br J Diabetes. 2016;16:154-5.

Mutairi NA, Amr Z, Sharma AK, Sheltani MA. Cutaneous Manifestation of Diabetes Mellitus, Study from Department of Dermatology, Farwaniya Hospital, Kuwait. Med Princ Pract. 2006;15:427-30.

Ko MJ, Chiu HC, Jee SH, Hu FC, Tseng CH. Postprandial blood glucose is associated with generalized pruritus in patients with type 2 diabetes. Eur J Dermatol. 2013;23:688-93.

Wang YR, Margolis D. The prevalence of diagnosed cutaneous manifestations during ambulatory diabetes visits in the United States, 1998–2002. Dermatology. 2006;212:229-34.

Mahajan S, Koranne RV, Sharma SK. Cutaneous manifestation of diabetes mellitus. Indian J Dermatol Venereol Leprol. 2003;69:105-8.

Demirseren DD, Emre S, Akoglu G, Arpacı D, Arman A, Metin A, et al. Relationship between skin diseases and extracutaneous complications of diabetes mellitus: clinical analysis of 750 patients. Am J Clin Dermatol. 2014;15:65-70.

Mandola A, Nozawa A, Eiwegger T. Histamine, histamine receptors, and anti-histamines in the context of allergic responses. LymphoSign Journal. 2019;6:35-51.

Ghajari MF, Golpayegani MV, Bargrizan M, Ansari G, Shayeghi S. Sedative effect of oral midazolam/hydroxyzine versus chloral hydrate/hydroxyzine on 2–6-year-old uncooperative dental patients: a randomized clinical trial. J Dent (Tehran). 2014;11:93-9.

Poradzka A, Jasik M, Karnafel W, Fiedor P. Clinical aspects of fungal infections in diabetes. Acta Pol Pharm. 2013;70:587-96.

Jannot-Lamotte MF, Raccah D. Management of diabetes during corticosteroid therapy. Presse Med. 2000;29:263-6.

Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-86.

Andrews RC, Walker BR. Glucocorticoids and insulin resistance: old hormones, new targets. Clin Sci (Lond). 1999;96:513-23.

Delaunay F, Khan A, Cintra A, Davani B, Ling ZC, Andersson A, et al. Pancreatic beta cells are important targets for the diabetogenic effects of glucocorticoids. J Clin Invest. 1997;100:2094-8.

Seité S, Khemis A, Rougier A, Ortonne JP. Importance of treatment of skin xerosis in diabetes. J Eur Acad of Dermatol Venereol. 2011;25:607-9.