Elevated skin autofluorescence is strongly associated with foot ulcers in patients with diabetes: a cross-sectional, observational study of Chinese subjects

Hu, Hang; Han, Chunmao; Hu, Xiaofan; Ye, Wan-lan; Huang, Wenjuan; Smit, Andries J.

doi:10.1631/jzus.b1100249

Cited by 26 publications

(66 citation statements)

References 21 publications

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“…Despite this moderately high VPT value, the highest sAF quartile was independently associated with increased VPT. High sAF has already been reported in patients with foot ulcers, the main morbidity of DPN [27,28]. Our results show that even before reaching a VPT that reflects a severe lesion of a large nerve fibre or a high risk of foot ulcer, sAF reflects the worsening of large fibre function.…”

Section: Discussionsupporting

confidence: 67%

Skin autofluorescence and peripheral neuropathy four years later in type 1 diabetes

Rajaobelina

Farges

Nov

et al. 2016

Diabetes Metabolism Res

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Objective Advanced glycation end products (AGEs) are involved in diabetes complications. We aimed to investigate whether the accumulation of AGEs measured by skin autofluorescence (sAF) was associated with signs of diabetic peripheral neuropathy and to sensitivity, pain, motor and autonomic function 4 years later in patients with type 1 diabetes.Methods At baseline, 188 patients (age 51 years, diabetes duration 22 years) underwent skin autofluorescence measurement using the AGE Reader. Four years later, signs of diabetic peripheral neuropathy were defined as the presence of neuropathic pain and/or feet sensory loss or foot ulceration. Neurological tests were systematically performed: vibration perception threshold by neuroesthesiometry, neuropathic pain by the Douleur Neuropathique en 4 Questions score, muscle strength by dynamometry and electrochemical skin conductance. Multivariate analyses were adjusted by age, sex, height, body mass index, tobacco, HbA 1c , diabetes duration, estimated glomerular filtration rate and albumin excretion rate.Results At the 4-year follow-up, 13.8% of patients had signs of diabetic peripheral neuropathy. The baseline sAF was higher in those with signs of diabetic peripheral neuropathy (2.5 ± 0.7 vs 2.1 ± 0.5 arbitrary units (AU), p < 0.0005). In the multivariate analysis, a 1 SD higher skin autofluorescence at baseline was associated with an increased risk of signs of neuropathy (OR = 2.68, p = 0.01). All of the neurological tests were significantly altered in the highest quartile of the baseline sAF (>2.4 AU) compared with the lowest quartiles after multivariate adjustment.Conclusion This non-invasive measurement of skin autofluorescence may have a value for diabetic peripheral neuropathy in type 1 diabetes and a potential clinical utility for detection of diabetic peripheral neuropathy.

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Section: Discussionsupporting

confidence: 67%

Skin autofluorescence and peripheral neuropathy four years later in type 1 diabetes

Rajaobelina

Farges

Nov

et al. 2016

Diabetes Metabolism Res

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“…We provide reference SAF data for the first time in a Saudi population with potential application in a wide-range of translational and clinical studies. Skin autofluorescence assessment is not only important for cardiovascular risk assessment 13 21 22 and diabetes screening 14 , but has also been shown to have diagnostic value in renal failure 23 24 25 , retinopathy 26 27 , neuropathy 28 29 , foot ulceration 30 31 32 and schizophrenia 33 . We show a gender dependent association of SAF with age, SR value, diabetes, hypertension and obesity, discussed below.…”

Section: Discussionmentioning

confidence: 99%

A new gender-specific model for skin autofluorescence risk stratification

Ahmad

Damanhouri

Kimhofer

et al. 2015

Sci Rep

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Advanced glycation endproducts (AGEs) are believed to play a significant role in the pathophysiology of a variety of diseases including diabetes and cardiovascular diseases. Non-invasive skin autofluorescence (SAF) measurement serves as a proxy for tissue accumulation of AGEs. We assessed reference SAF and skin reflectance (SR) values in a Saudi population (n = 1,999) and evaluated the existing risk stratification scale. The mean SAF of the study cohort was 2.06 (SD = 0.57) arbitrary units (AU), which is considerably higher than the values reported for other populations. We show a previously unreported and significant difference in SAF values between men and women, with median (range) values of 1.77 AU (0.79–4.84 AU) and 2.20 AU (0.75–4.59 AU) respectively (p-value « 0.01). Age, presence of diabetes and BMI were the most influential variables in determining SAF values in men, whilst in female participants, SR was also highly correlated with SAF. Diabetes, hypertension and obesity all showed strong association with SAF, particularly when gender differences were taken into account. We propose an adjusted, gender-specific disease risk stratification scheme for Middle Eastern populations. SAF is a potentially valuable clinical screening tool for cardiovascular risk assessment but risk scores should take gender and ethnicity into consideration for accurate diagnosis.

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“…Numerous studies with the skin readers have shown that autofluorescence correlated strongly with the development of nephropathy [ 38 ] and neuropathy [ 39 ] including its association with the development of diabetic foot ulcers [ 40 ]. Conversely, its association with retinopathy was not nearly as strong.…”

Section: Discussionmentioning

confidence: 99%

Skin collagen fluorophore LW-1 versus skin fluorescence as markers for the long-term progression of subclinical macrovascular disease in type 1 diabetes

Sell

Sun

Gao

et al. 2016

Cardiovasc Diabetol

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BackgroundSkin collagen Long Wavelength Fluorescence (LWF) is widely used as a surrogate marker for accumulation of advanced glycation end-products. Here we determined the relationship of LWF with glycemia, skin fluorescence, and the progression of complications during EDIC in 216 participants from the DCCT.MethodsLW-1 and collagen-linked fluorescence (CLF) were measured by either High Performance Liquid Chromatography (HPLC) with fluorescence detection (LW-1) or total fluorescence of collagenase digests (CLF) in insoluble skin collagen extracted from skin biopsies obtained at the end of the DCCT (1993). Skin intrinsic fluorescence (SIF) was noninvasively measured on volar forearm skin at EDIC year 16 by the SCOUT DS instrument.ResultsLW-1 levels significantly increased with age and diabetes duration (P < 0.0001) and significantly decreased by intensive vs. conventional glycemic therapy in both the primary (P < 0.0001) and secondary (P < 0.037) DCCT cohorts. Levels were associated with 13–16 year progression risk of retinopathy (>3 sustained microaneurysms, P = 0.0004) and albumin excretion rate (P = 0.0038), the latter despite adjustment for HbA1c. Comparative analysis for all three fluorescent measures for future risk of subclinical macrovascular disease revealed the following significant (P < 0.05) associations after adjusting for age, diabetes duration and HbA1c: coronary artery calcium with SIF and CLF; intima-media thickness with SIF and LW-1; and left ventricular mass with LW-1 and CLF.ConclusionsLW-1 is a novel risk marker that is robustly and independently associated with the future progression of microvascular disease, intima-media thickness and left ventricular mass in type 1 diabetes.Trial registration NCT00360815 and NCT00360893 at clinicaltrials.govElectronic supplementary materialThe online version of this article (doi:10.1186/s12933-016-0343-3) contains supplementary material, which is available to authorized users.

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Elevated skin autofluorescence is strongly associated with foot ulcers in patients with diabetes: a cross-sectional, observational study of Chinese subjects

Cited by 26 publications

References 21 publications

Skin autofluorescence and peripheral neuropathy four years later in type 1 diabetes

Skin autofluorescence and peripheral neuropathy four years later in type 1 diabetes

A new gender-specific model for skin autofluorescence risk stratification

Skin collagen fluorophore LW-1 versus skin fluorescence as markers for the long-term progression of subclinical macrovascular disease in type 1 diabetes

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