Evaluation of Cutaneous Manifestations in Patients With Diabetes Mellitus: Association With Non-alcoholic Fatty Liver Disease and Other Gastrointestinal Complications.

Introduction Cutaneous manifestations occur in approximately 30-70% of patients with diabetes mellitus (DM) and frequently serve as visible indicators of underlying systemic complications, such as non-alcoholic fatty liver disease (NAFLD) and gastrointestinal (GI) disturbances. Early recognition of these dermatological signs can facilitate timely diagnosis, improve risk stratification, and contribute to more comprehensive metabolic management. Given the shared metabolic pathways among skin, hepatic, and GI abnormalities, exploring their interrelationships may provide insight into the systemic nature of diabetes. Objective To evaluate the prevalence and pattern of cutaneous manifestations among diabetic patients and to determine their association with NAFLD and GI complications. We hypothesized that specific cutaneous manifestations may correlate with hepatic and GI involvement in diabetes. Materials and methods A cross-sectional analytical study was conducted at Lady Reading Hospital (LRH), Peshawar, Pakistan, over 12 months, enrolling 328 patients with DM. Participants were evaluated for cutaneous manifestations, GI symptoms, and NAFLD confirmed by abdominal ultrasonography. A structured proforma was used to record demographic and clinical parameters, including age, gender, body mass index (BMI), duration of diabetes, and HbA1c. GI symptoms were assessed using a self-designed, structured symptom checklist developed in consultation with gastroenterologists and pretested for clarity and consistency. Data were analyzed using SPSS Statistics, version 26.0 (IBM Corp., Armonk, NY). Associations were determined using the chi-square and Fisher's exact tests, while multivariate logistic regression was applied to identify independent predictors of NAFLD after adjusting for confounders. Results Cutaneous manifestations were identified in 226 (68.9%) participants, with acanthosis nigricans (n = 92; 28.0%) and diabetic dermopathy (n = 84; 25.6%) being the most frequent findings. NAFLD was present in 138 (42.1%) patients and showed a significant association with cutaneous manifestations (108/226 [47.8%] vs. 30/102 [28.3%], p = 0.001). Among GI symptoms, constipation (p = 0.02) and bloating (p = 0.04) were significantly more prevalent in patients with skin changes, whereas diarrhea and nausea/vomiting did not demonstrate significant associations. Multivariate logistic regression identified cutaneous manifestations (OR = 2.05, 95% CI: 1.25-3.35, p = 0.004), BMI ≥ 30 kg/m² (OR = 3.12, 95% CI: 1.88-5.19, p < 0.001), and HbA1c ≥ 8% (OR = 1.67, 95% CI: 1.02-2.74, p = 0.04) as independent predictors of NAFLD. Conclusion NAFLD and several GI disturbances are significantly associated with cutaneous manifestations in diabetic patients. These dermatological findings, being non-invasive and easily observable, may serve as valuable clinical indicators for identifying individuals at risk of systemic metabolic dysfunction. Integrating dermatological evaluation into routine diabetes care could support earlier detection, comprehensive management, and targeted prevention of hepatic and GI complications.