Skin Autofluorescence

Abstract

OBJECTIVE -Skin autofluorescence is a noninvasive measure of the level of tissue accumulation of advanced glycation end products, representing cumulative glycemic and oxidative stress. Recent studies have already shown a relationship between skin autofluorescence and diabetes complications, as well as the predictive value of skin autofluorescence for total and cardiovascular mortality in type 2 diabetes. Our aim was to investigate the predictive value of skin autofluorescence for the development of microvascular complications in type 2 diabetes.RESEARCH DESIGN AND METHODS -At baseline, skin autofluorescence of 973 type 2 diabetic patients with well-controlled diabetes was noninvasively measured with an autofluorescence reader. The aggregate clinical outcome was defined as the development of any diabetes-associated microvascular complication of 881 surviving patients, which was assessed at baseline and at the end of follow-up. Single end points were the development of diabetesassociated retinopathy, neuropathy, and (micro)albuminuria. RESULTS-After a mean follow-up period of 3.1 years, baseline skin autofluorescence was significantly higher in patients who developed any microvascular complication, neuropathy, or (micro)albuminuria but not in those who developed retinopathy. Multivariate analyses showed skin autofluorescence as a predictor for development of any microvascular complication along with A1C, for development of neuropathy along with smoking, and for development of (micro)albuminuria together with sex, A1C, and diabetes duration. Skin autofluorescence did not have predictive value for the development of retinopathy, albeit diabetes duration did.CONCLUSIONS -Our study is the first observation of skin autofluorescence measurement as an independent predictor of development of microvascular complications in type 2 diabetes.

Skin Autofluorescence and All-Cause Mortality in Stage 3 CKD

“…When considering cardiovascular risk, for United Kingdom populations, the QRisk2 score seems to achieve better predictive accuracy for CVD than the Framingham score by incorporating other comorbidities, including CKD (although CKD is treated as a simple dichotomous variable in QRisk2) (41,42). Use of skin AF has been proposed as a tool to aid the identification of people at risk of complications in diabetes (17,43). Although improved cardiovascular risk prediction in people with CKD would help target interventions, such as statins, our study does not provide evidence to support such use of skin AF in CKD stage 3.…”

Skin Advanced Glycation End Product Accumulation is Poorly Reflected by Glycemic Control in Type 2 Diabetic Patients (ZODIAC-9)

“…This newly developed device measures certain tissue AGEs, with the concept of reflecting metabolic control over several years, and has already been established as a risk marker for micro-and macrovascular complications and mortality in T2DM. 4,5 Controlling glycemic and metabolic status is an important issue in preventing long-term diabetic complications, and it is not clearly defined which marker for metabolic control over a certain period is the best predictor in relation to the development of chronic diabetic complications. We hypothesized that the accumulation of AGEs in type 2 diabetes patients can be predicted by the course of HbA1c during a certain period prior to the skin autofluorescence (AF) measurement.…”

“…This was found for microvascular complications as well as for macrovascular morbidity and mortality. 4,5 The mainstay of diabetes management is the prevention of chronic complications, especially cardiovascular disease. The presence of a considerable number of patients with micro-and macrovascular disease in our well-controlled study population at baseline supports the consensus that HbA1c parameters, reflecting at best medium-term glycemic control, cannot be considered as a substitute for the use of skin AF, reflecting the accumulation of AGEs with its vasculardamaging effects.…”

Malondialdehyde and Pentosidine in Young Type 1 Diabetic Patients

“…AGE level (especially carboxy methyl lysine) is a strong predictor for the development and progression of microvascular complications including nephropathy [5]. AGEs have a predictive value for the development of microvascular complications, which was found to be superior to other common risk predictors, such as diabetes duration and HbA1c [6].…”