Arch Dermatol：银屑病导致2型糖尿病风险增加

近日据HealthDay News报道，患牛皮癣的人患2型糖尿病的风险大大增加。

费城宾夕法尼亚大学皮肤科副教授Joel Gelfand说，牛皮癣的人独立于传统的危险因素如肥胖等也会增加糖尿病风险。Gelfand说，这种风险可能具有遗传性，或许牛皮癣可能导致胰岛素抵抗增加。

他还指出，肥胖是一种牛皮癣以及糖尿病的共同危险因素。患牛皮癣的人应尽量保持健康的身体体重以预防糖尿病。

这项研究论文发表在6月18日的Archives of Dermatology杂志上。

研究团队收集了超过British Health Improvement Network中记载的 108,000名银屑病患者数据，将这些患者数据与未患皮肤疾病的430,000人进行比较。

研究人员发现轻度银屑病患者患2型糖尿病的风险高出11％，严重的牛皮癣的患者患2型糖尿病的风险高出46％。

此外，研究人员发现，患有严重的牛皮癣的人更可能要服用糖尿病药物。

研究人员推测，由于牛皮癣和糖尿病都是部分由体内炎症引起的，这项研究可能解释了两者之间致病原因​之间的联系。他们指出炎症可以增加胰岛素抵抗，这是2型糖尿病的一个原因。

尽管这项研究表明银屑病和2型糖尿病之间的关联，但它并不能证明两者之间是否是因果关系。

doi:10.1001/archdermatol.2012.36
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A Patient Decision Aid for Psoriasis Based on Current Clinical Practice Guidelines

Jerry Tan, MD, FRCPC; Barat Wolfe, MA

Objective To develop a patient decision aid (PDA) for psoriasis with content derived from current clinical practice guidelines.

Design This PDA was developed in accordance with international patient decision aid standards. Primary sources of treatment outcome information were English-language, evidence-based clinical practice guidelines for plaque psoriasis published between January 1, 2006, and December 31, 2010.

Setting Patients with psoriasis from a private practice in Windsor, Ontario, Canada, and a focus group of dermatologists across Canada.

Participants Focus groups of dermatologists (n = 5) and patients with psoriasis (n = 7) were convened to provide feedback on balance, clarity, practicality, and items for inclusion and exclusion.

Main Outcome Measures Physician's global assessment, overall lesional assessment, and 75% reduction in Psoriasis Area and Severity Index.

Results Efficacy measures selected to reflect good control in the PDA were physician's global assessment (clear or almost clear) or overall lesional assessment (none or very mild) for topical agents and 75% reduction in Psoriasis Area and Severity Index for phototherapy and systemic agents. Where available, outcomes for serious adverse effects were displayed figuratively with efficacy measures. Deliberative questions for self-completion and a values clarification exercise were also incorporated.

Conclusion This psoriasis PDA was developed according to international standards based on content derived from current clinical practice guidelines.