Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Center for Diabetes Research, Department of Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
J Am Acad Dermatol. 2015 Apr;72(4):599-605. doi: 10.1016/j.jaad.2015.01.004. Epub 2015 Feb 1.
Patients with psoriasis have increased risk of type 2 diabetes. The pathophysiology is largely unknown, but it is hypothesized that systemic inflammation causes insulin resistance. Insulin sensitivity has only been sparsely investigated in patients with psoriasis, and previous studies have used suboptimal methodology. The hyperinsulinemic euglycemic clamp remains the gold standard for quantifying whole-body insulin sensitivity.
We sought to investigate if normal glucose-tolerant patients with psoriasis exhibit impaired insulin sensitivity.
Three-hour hyperinsulinemic euglycemic clamps were performed in 16 patients with moderate to severe, untreated psoriasis and 16 matched control subjects.
The 2 groups were similar with regard to age, gender, body mass index, body composition, physical activity, fasting plasma glucose, and glycosylated hemoglobin. Mean ± SEM psoriasis duration was 23 ± 3 years and Psoriasis Area and Severity Index score was 12.7 ± 1.4. Patients with psoriasis exhibited reduced insulin sensitivity compared with control subjects (median M-value 4.5 [range 1.6-14.0] vs 7.4 [range 2.1-10.8] mg/kg/min, P = .046). There were no differences between groups in plasma glucose, insulin, C-peptide, and glucagon during the clamp.
The classic hyperinsulinemic euglycemic clamp technique does not allow assessment of endogenous glucose production.
Patients with psoriasis were more insulin resistant compared with healthy control subjects. This supports that psoriasis may be a prediabetic condition.
银屑病患者患 2 型糖尿病的风险增加。其病理生理学在很大程度上尚不清楚，但据推测，系统性炎症导致胰岛素抵抗。银屑病患者的胰岛素敏感性仅得到了稀疏的研究，并且先前的研究使用了次优的方法。高胰岛素-正常血糖钳夹仍然是量化全身胰岛素敏感性的金标准。
我们旨在研究是否有葡萄糖耐量正常的银屑病患者表现出胰岛素敏感性受损。
对 16 名中重度未经治疗的银屑病患者和 16 名匹配的对照者进行 3 小时高胰岛素-正常血糖钳夹。
两组在年龄、性别、体重指数、身体成分、体力活动、空腹血糖和糖化血红蛋白方面相似。银屑病的平均±SEM 病程为 23±3 年，银屑病面积和严重程度指数评分（PASI）为 12.7±1.4。与对照组相比，银屑病患者的胰岛素敏感性降低（中位数 M 值 4.5[范围 1.6-14.0]与 7.4[范围 2.1-10.8]mg/kg/min，P=0.046）。在钳夹过程中，两组之间的血浆葡萄糖、胰岛素、C 肽和胰高血糖素没有差异。
经典的高胰岛素-正常血糖钳夹技术不允许评估内源性葡萄糖生成。
与健康对照组相比，银屑病患者的胰岛素抵抗更明显。这支持银屑病可能是一种糖尿病前期状态。
