March 23, 2015
Journal of the American Academy of Dermatology
April 2015 Volume 72, Issue 4, Pages 599–605
TAKE-HOME MESSAGE
- Psoriasis is known to be associated with type 2 diabetes, but little is known about insulin sensitivity and psoriasis. The authors of this study used the hyperinsulinemic euglycemic clamp, which is the gold standard for assessing insulin sensitivity, in 16 patients with psoriasis and 16 controls.
- Patients with psoriasis showed reduced insulin sensitivity when compared with the matched control group.
Dermatology
Written by Robert T Brodell MD
It is not certain that a larger study would confirm these findings, but acanthosis nigricans, skin tags, and finger pebbles are hyperplasias of the skin that are associated with insulin resistance and hyperinsulinemia. Perhaps individuals with a genetic predisposition to psoriasis more easily develop epidermal hyperplasia due to hyperinsulinemia. The complexities of psoriasis and the metabolic syndrome continue to evolve. It is amazing that nothing was known of these relationships a mere decade ago.
Abstract
BACKGROUND
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.
OBJECTIVE
We sought to investigate if normal glucose-tolerant patients with psoriasis exhibit impaired insulin sensitivity.
METHODS
Three-hour hyperinsulinemic euglycemic clamps were performed in 16 patients with moderate to severe, untreated psoriasis and 16 matched control subjects.
RESULTS
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.
LIMITATIONS
The classic hyperinsulinemic euglycemic clamp technique does not allow assessment of endogenous glucose production.
CONCLUSION
Patients with psoriasis were more insulin resistant compared with healthy control subjects. This supports that psoriasis may be a prediabetic condition.