Abstract
Aims: Psoriasis is an immune-mediated dermatosis with cardio-metabolic comorbidities. The aim of this study was to assess insulin-resistance, lipid abnormalities, and cardiovascular risk biomarkers in psoriatic patients with or without type 2 diabetes mellitus (T2DM).Methods and materials: We enrolled 425 patients: 86 psoriatics, 69 psoriatics with T2DM, 120 T2DM patients, and 150 healthy subjects. We measured the Psoriasis Area and Severity Index (PASI), body mass index (BMI), insulin-resistance parameters [glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), fasting plasma insulin (FPI), and with homeostasis model assessment index (HOMA index)], lipidic panel, plasminogen activator inhibitor-1 (PAI-1), homocysteine, soluble adhesion molecules, matrix metalloproteinase, and adipocytokines.Results: FPG, HbA1c, and HOMA-IR were higher in diabetics with psoriasis (p < 0.0001) than in psoriatics. FPI levels were higher in diabetics with psoriasis than in diabetics and psoriatics (p < 0.0001), and higher in psoriatics than controls (p < 0.0001). Psoriatics and diabetics with psoriasis showed higher triglyceride and LDL-C levels (p < 0.0001) than diabetics. Homocysteine was higher in psoriatics and diabetics with psoriasis (p < 0.0001) than in diabetics. PAI-1 was higher in diabetics with psoriasis than diabetics (p < 0.01). sICAM-1 and sVCAM-1 were higher in diabetics with psoriasis than diabetics (p < 0.001 and p < 0.01) and psoriatics (p < 0.001 and p < 0.0001). Visfatin and resistin were lower in psoriatics (p < 0.0001) and in diabetics with psoriasis (p < 0.001 and p < 0.0001, respectively) than diabetics.Conclusions: A limitation of this study is that there is a significant difference in mean age between controls and other study groups: the lack of matching between case and control groups may interfere with the external validity of the study findings. Despite this, the study highlights a pathogenetic link between psoriasis, considered a pre-diabetic condition, and diabetes. Insulin-resistance seems to be the keystone of psoriasis comorbidities. Psoriasis reinforces diabetes, causing a greater cardiometabolic risk.
Highlights
Psoriasis (PsO) is an immune-mediated inflammatory disease (IMID) affecting the skin and characterized by keratinocyte hyperproliferation and T-lymphocyte inflammation, with a world prevalence of 2–4% [1]
A total of 425 subjects were enrolled in the study (150 healthy controls, 120 diabetics, 86 psoriatics, and 69 diabetics with psoriasis)
Lower BMI was obtained in psoriatics (p < 0.0001) and diabetics with psoriasis (p < 0.05) compared to diabetics (Table 1)
Summary
Psoriasis (PsO) is an immune-mediated inflammatory disease (IMID) affecting the skin and characterized by keratinocyte hyperproliferation and T-lymphocyte inflammation, with a world prevalence of 2–4% [1]. Patients with psoriasis have an increased risk of new-onset of T2DM [5]. Several epidemiological studies reported that the average prevalence of T2DM in psoriatic cohorts was 11.6% [6]. Other studies that examined the prevalence of T2DM in psoriatic patients compared to controls showed heterogeneous data that do not allow to make a realistic estimate, but sustain an increased prevalence of T2DM in psoriatic cohorts compared to healthy subjects, especially for late onset psoriasis [6]. A no correlation was observed between T2DM prevalence and psoriasis severity [6]
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