Introduction and Objective: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with obesity, insulin resistance, and type 2 diabetes. Whether HS is associated with differential real-world initiation and use of insulin-sensitizing therapy is not well understood. Methods: We conducted a retrospective cohort study using the NIH All of Us Research Program. Adults aged ≥18 years with HS were identified using validated diagnostic codes and compared with participants without HS. Outcomes included ever-use and time to initiation of metformin and glucagon-like peptide-1 receptor agonists (GLP-1RA). Multivariable logistic regression and Cox proportional hazards models examined odds and timing of treatment initiation, adjusting for age, sex, race, body mass index (BMI), chronic kidney disease, and heart failure. Results: Among 2,636 adults with HS (mean 43.3 SD 13.8 years; 79% female; mean BMI 36.4 SD 9.5 kg/m²), 16.8% used a GLP-1RA and 30.7% used metformin after HS diagnosis. Compared with participants without HS, HS was associated with higher odds of GLP-1RA use (adjusted odds ratio aOR 3.30; 95% CI 2.90-3.75) and metformin use (aOR 3.39; 95% CI 3.04-3.77). HS was also associated with faster initiation of GLP-1RA (adjusted hazard ratio aHR 1.61; 95% CI 1.19-2.19) and metformin (aHR 1.50; 95% CI 1.18-1.90). Associations persisted after accounting for obesity and cardio-kidney-metabolic comorbidities. Conclusion: HS is associated with earlier and more frequent use of metformin and GLP-1RAs independent of further metabolic burden, yet absolute uptake remains modest given high cardiometabolic risk among patients with HS. These findings highlight persistent treatment gaps and opportunities to optimize metabolic care and improve outcomes in this high-risk population. Disclosure R. Shrestha: None. G. Nguyen: None. R. McCoy: None.
Shrestha et al. (Fri,) studied this question.