JEADV ISSN 1468-3083 JEADV 2006, 20, 391–395 © 2006 European Academy of Dermatology and Venereology 391 Blackwell Publishing Ltd ORIGINAL ARTICLE Peripheral insulin resistance in patients with Behçet’s disease H Erdem,*† A Dinc,† S Pay,† I Simsek,† M Turan‡ † Division of Rheumatology of the Department of Medicine, and ‡ Department of Hydroclimatology, Gulhane Military Medical Academy, Etlik/Ankara 06018, Turkey Keywords Behçet’s disease, endothelial dysfunction, inflammation, insulin resistance *Corresponding author, tel. +90 312 3043974; fax +90 312 3043960; E-mail: herdem67@gata.edu.tr Received: 6 October 2004, accepted: 24 January 2005 DOI: 10.1111/j.1468-3083.2006.01457.x Abstract In this study, we examined peripheral insulin resistance in patients with Behçet’s disease (BD) characterized by chronic inflammation and endothelial dysfunction. Fourteen patients with BD and 15 healthy controls were recruited to the study. Insulin resistance was investigated by the hyperinsulinaemic– euglycaemic glucose clamp technique. BD patients displayed an enhanced rate of insulin resistance compared to healthy controls ( P = 0.014). The insulin sensitivity ( M ), measured as the glucose utilization rate under steady-state conditions of euglycaemia, was significantly decreased ( P = 0.001) in BD patients compared to the controls (4.09 ± 0.16 vs. 5.60 ± 0.27 mg/kg/min). The C-reactive protein (CRP) level, but not the erythrocyte sedimentation rate (ESR), was significantly related to the presence of insulin resistance (CRP: r s = 0.589, P = 0.27; ESR: r s = 0444, P = 0112), whereas no relationship was found between the M -value and ESR or CRP. We conclude that patients with BD exhibit peripheral insulin resistance; this could be explained as the diverse consequences of inflammation and endothelial dysfunction in BD. Introduction Behçet’s disease (BD) is a chronic, multisystem inflammatory disorder of unknown aetiology that has vasculitic features that may involve vessels of any size. The clinical manifestations of BD include recurrent oral and genital ulcers, uveitis, and arterial and venous invo- lvement, including aneurysms and thrombotic occlusion. 1 Insulin resistance is a metabolic syndrome associated with a defect in the ability of tissues to respond to insulin. Reduced glucose utilization of peripheral tissues and consequent hyperinsulinaemia are the hallmarks of this condition. 2 Peripheral glucose handling is reported to be impaired in rheumatoid arthritis (RA) and in other connective tissue diseases, 3,4 and this abnormality is mainly due to peripheral insulin resistance. 4,5 Increased frequency of cardiovascular disease (CVD) and its pos- sible links with insulin resistance have been reported in patients with RA. 6–8 There are no data currently available concerning the insulin resistance in BD. In this study, the peripheral insulin resistance and its relationship to the acute-phase response were investigated in patients with BD. Patients and methods Fourteen patients with BD and 15 healthy controls were included in the study. All patients fulfilled the criteria of the International Study Group for BD. 9 Patients with BD were matched to healthy controls with respect to age, gender and body mass index (BMI). Lipid profiles of patients and controls were comparable (Table 1). None of the patients had been treated with oral corticosteroids during the previous 3 months. If in use, non-steroidal anti- inflammatory drugs (NSAIDs) were withdrawn 5 days before the investigation. None of the subjects were obese, hypertensive and had any clinical or laboratory findings suggesting endocrine, infectious or malignant disorders. The local ethical committee approved the study and all participants gave their informed consent. An oral glucose tolerance test (OGTT) was performed on each subject before the study and none of them showed a diabetic pattern. Insulin resistance was investi- gated by the hyperinsulinaemic–euglycaemic glucose clamp technique, as described by De Fronzo et al . 10 In each subject, blood samples were collected from the brachial vein and erythrocyte sedimentation rate (ESR),