HS and Diabetes: The Metabolic Connection
Hidradenitis suppurativa and type 2 diabetes share deep metabolic and inflammatory roots. Understanding this connection can help patients and clinicians take a more comprehensive approach to managing both conditions.
Medical Disclaimer: This article is for educational purposes only. Diabetes management requires professional medical care. Do not adjust diabetes medications without physician guidance. Read full disclaimer.
For many people with hidradenitis suppurativa, HS is not the only chronic condition they are managing. Research consistently shows that HS patients have significantly higher rates of type 2 diabetes, insulin resistance, and metabolic syndrome compared to the general population - and compared to patients with other chronic skin conditions.
This is not a coincidence. HS and type 2 diabetes share overlapping inflammatory pathways, and each condition can worsen the other. Understanding this bidirectional relationship is increasingly recognized as essential to comprehensive HS care. HS also frequently co-occurs with other metabolic conditions - learn about the link between HS and anemia and how hormonal factors contribute to disease activity.
Key Statistic
A large cross-sectional study of 3,207 HS patients found that metabolic syndrome was present in approximately 40% of HS patients - significantly higher than age- and sex-matched controls. Type 2 diabetes was approximately 2-3 times more prevalent in HS patients compared to the general population.[2]
Why HS and Diabetes Are Linked
The connection between HS and diabetes is not simply that both are more common in people with obesity. The relationship is more fundamental, involving shared inflammatory pathways and bidirectional metabolic effects.
Chronic Inflammation Drives Insulin Resistance
The inflammatory cytokines elevated in HS - particularly TNF-alpha, IL-1, and IL-6 - directly interfere with insulin signaling in muscle, fat, and liver cells. This is the same mechanism by which obesity causes insulin resistance, and HS adds an additional inflammatory burden on top of any weight-related effects.
Insulin Resistance May Worsen HS
Hyperinsulinemia (elevated insulin levels from insulin resistance) stimulates androgen production in the ovaries and adrenal glands, potentially worsening HS through increased androgenic stimulation of hair follicles. High insulin also promotes IGF-1 signaling, which stimulates keratinocyte proliferation.
Shared Risk Factors
Obesity, sedentary lifestyle, and a pro-inflammatory diet increase risk for both HS and type 2 diabetes. Addressing these shared risk factors through lifestyle modification can benefit both conditions simultaneously.
Adipose Tissue as an Inflammatory Organ
Excess adipose tissue (body fat), particularly visceral fat, secretes pro-inflammatory adipokines that contribute to both insulin resistance and systemic inflammation. This creates a self-reinforcing cycle that worsens both HS and metabolic disease.
Metabolic Screening for HS Patients
Given the high prevalence of metabolic comorbidities in HS, many guidelines recommend routine metabolic screening for HS patients. Ask your physician about the following tests if you have not had them recently:
| Test | What It Screens For | Frequency |
|---|---|---|
| Fasting glucose | Diabetes and pre-diabetes | Annually |
| HbA1c | Average blood sugar over 3 months | Annually |
| Fasting lipid panel | Cholesterol, triglycerides | Annually |
| Blood pressure | Hypertension | Every visit |
| BMI / waist circumference | Obesity, metabolic risk | Every visit |
| Insulin / HOMA-IR | Insulin resistance | As indicated |
Managing HS and Diabetes Together
Anti-Inflammatory Diet
A diet that reduces systemic inflammation benefits both HS and metabolic health. Key principles include reducing refined carbohydrates and added sugars (which drive insulin spikes), increasing fiber from vegetables and legumes, emphasizing omega-3 fatty acids, and eliminating or reducing dairy and high-glycemic foods that may trigger HS flares.
See our Nutrition and Lifestyle GuideWeight Management
Even modest weight loss (5-10% of body weight) can significantly improve insulin sensitivity, reduce systemic inflammation, and improve HS disease activity. Bariatric surgery has been associated with HS improvement in case reports and small series.
Exercise
Regular physical activity improves insulin sensitivity and reduces systemic inflammation. HS can make exercise painful, but low-impact options (swimming, cycling, walking) are often feasible even during flares. See our HS Exercise Guide for HS-specific exercise strategies.
See the HS Exercise GuideMetformin
Metformin, the most commonly prescribed type 2 diabetes medication, reduces insulin resistance and has indirect anti-androgenic effects. Small studies suggest modest benefit in HS patients, particularly those with concurrent metabolic syndrome or PCOS. Discuss with your physician.
GLP-1 Receptor Agonists
GLP-1 receptor agonists (semaglutide/Ozempic, liraglutide) are increasingly used for both type 2 diabetes and weight management. Emerging case reports and small studies suggest these medications may also benefit HS, possibly through weight loss and anti-inflammatory effects. This is an active area of research.