Cross-Sectional Evaluation of Noninvasively Detected Skin Intrinsic Fluorescence and Mean Hemoglobin A1c in Type 1 Diabetes

Abstract

Background: This study evaluated the relationship between skin intrinsic fluorescence (SIF) and long-term mean hemoglobin A1c (HbA1c) in individuals with type 1 diabetes. Subjects and Methods: We undertook a cross-sectional analysis of 172 individuals with type 1 diabetes followed longitudinally with HbA1c data available over an average of 16.6 years. SIF was evaluated cross-sectionally using the SCOUT DS Ò device (VeraLight Inc., Albuquerque, NM) and correlated with most recent HbA1c and long-term mean HbA1c. Potential determinants of this relationship, including age, gender, smoking status, duration of diabetes, and renal function, were also evaluated. Results: Age-adjusted skin intrinsic fluorescence significantly correlated with long-term mean HbA1c (R = 0.44, P < 0.0001). In contrast, there was no significant relationship between SIF and most recent HbA1c (R = 0.14, P = 0.075). The best-fit model describing the relationship between SIF and mean HbA1c controlled for factors of age, duration of disease, renal function, and site of study conduct. Controlling for these factors was also important in understanding the relationship between most recent HbA1c and SIF. Evaluating longer-term HbA1c data also strengthened the relationship between SIF and mean HbA1c. In the presence of renal dysfunction or damage, as indicated by an estimated glomerular filtration rate of < 60 mL/min/ 1.73 m 2 or presence of gross proteinuria, there was no significant correlation between SIF and mean HbA1c. Conclusions: Noninvasive detection of SIF significantly correlates with long-term mean HbA1c, providing insight into longterm glycemic exposure. Age, duration of diabetes, and renal function are potential contributors to this relationship.

Association of advanced glycation end products and chronic kidney disease with macroangiopathy in type 2 diabetes

“…In these patients, who are generally younger and healthier than ours, several recent studies have shown that the association between skin autofluorescence, or intrinsic fluorescence, and the mean of HbA1C from the previous years and decades is stronger when a longer duration of glycemic exposure is studied (Cleary et al 2013;Sugisawa et al, 2013). In some reports, the correlation with the most recent HbA1C was not significant (Aroda et al, 2013;Geneviève et al, 2013 ). In children with Type 1 Diabetes, who usually do not have other chronic conditions, the correlation between HbA1C of the previous years and skin intrinsic fluorescence is significant but not strong (Felipe et al, 2011): the association with the autofluorescence of the non diabetic siblings appears stronger (Barat et al, 2012).…”

Higher skin autofluorescence in young people with Type 1 diabetes and microvascular complications

“…As serum AGEs are renally excreted, impairment of renal function can lead to AGE accumulation and may be a confounder in adult studies; however, there are limited published data on AGE accumulation and their microvascular associations in young people with Type 1 diabetes before the onset of clinically significant renal impairment. The relative contribution of current HbA 1c vs glycaemic history in this age group, with relatively short diabetes duration, has not been described previously.…”

Relationship Between Skin Intrinsic Fluorescence—an Indicator of Advanced Glycation End Products—and Upper Extremity Impairments in Individuals With Diabetes Mellitus

“…Further, the noninvasive dermal SIF may be a better marker for understanding the musculoskeletal complications in individuals with DM than blood or serum markers because the turnover of collagen is so much longer than that of red blood cells (18 years vs 3-4 months). 28,29 For example, the SIF has been reported to be more strongly associated with the presence of peripheral neuropathy than the mean 18-year average of the HbA1c. 25 In our study, the SIF measures were related to the biceps tendon thickness, upper extremity movement and pain and disability, but not to supraspinatus tendon thickness.…”

“…[25][26][27] Estimating AGE levels in the skin is particularly beneficial because AGEs that accumulate in the skin have an estimated half-life of 15-20 years, and therefore, are a good indicator of long-term glycemic exposure of collagen-rich tissues. 28,29 Previous research has shown that this SIF measure is correlated with the severity of tissuespecific diabetes related complications such as peripheral neuropathy (seen mainly in the distal lower extremities), increased arterial stiffness, and nephropathy. 25,30,31 A 2014 study by Larkin et.…”