Evaluating the association between isotretinoin use in acne patients and diabetes risk: A retrospective cohort study.

Summary: Abstract Body: Recent reports of new-onset diabetes and worsening insulin resistance in acne patients after starting isotretinoin present conflicting evidence compared to existing cohort studies, which found no association between isotretinoin and insulin resistance. To evaluate whether isotretinoin increases type 1 (T1DM) and type 2 diabetes mellitus (T2DM) risk, we used the TriNetX US Collaborative network (66 healthcare organizations) to identify acne patients 9-40 years old via ICD-10-CM codes and stratified them into 4 treatment cohorts: 1. Isotretinoin; 2. Topical retinoids; 3. Spironolactone; 4. Oral tetracyclines. Cohorts were 1:1 propensity score matched to controls with baseline demographics and potential confounding comorbidities. 2-year Cox proportional hazards models with 95% confidence intervals (CIs) were used to assess risk of T1DM and T2DM development. Compared to topical retinoids, isotretinoin use had no significant difference in T1DM risk (hazard ratio (HR) [95% CI] = 0.98 [0.51, 1.87]) or T2DM risk (HR [95% CI] = 0.73 [0.49, 1.11]). Compared to spironolactone, isotretinoin use had no significant difference in T1DM risk (HR [95%] = 0.39 [0.12, 1.21]) and a significantly decreased risk of T2DM (HR [95% CI] = 0.42, [0.25, 0.71]). Compared to oral tetracyclines, isotretinoin use had no significant difference in T1DM risk (HR [95% CI] = 0.73 [0.40, 1.33]) and a significantly decreased risk of T2DM (HR [95%] = 0.52, 0.35, 0.77]). Sensitivity analyses excluding patients with obesity and PCOS revealed similar results. These findings provide reassuring support that isotretinoin is not associated with an increased risk of T1DM or T2DM in acne patients. David Garate¹, Christopher J. Thang¹, Jenny Lai², George Golovko³, Michael G. Wilkerson⁴, John S. Barbieri⁵ 1. The University of Texas Medical Branch John Sealy School of Medicine, Galveston, TX, United States. 2. Harvard Medical School, Boston, MA, United States. 3. Department of Pharmacology and Toxicology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States. 4. Department of Dermatology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States. 5. Department of Dermatology, Brigham and Women's Hospital, Boston, MA, United States. Clinical Research: Epidemiology and Observational Research