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

Abstract

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.

Lens autofluorescence ratio as a noninvasive marker of peripheral diabetic neuropathy

“…[30][31][32] In accordance with the literature, we also found that both the monofilament and neurothesiometer tests reported a higher risk of neuropathy in those groups with high LFRs. 29 In this study, we also found significant relationships between the LFR and both HbA 1c levels and the duration of diabetes, which is consistent with the literature. 33,34 On the other hand, we did not find any relation with age and lens fluorescence.…”

Progression of skin autofluorescence of AGEs over 4 years in patients with type 1 diabetes

“…In 240 patients with type 1 diabetes, we measured sAF during year 2009 . We have recently reported that these sAF were associated to diabetic peripheral neuropathy and that they predicted later estimated glomerular filtration rates and cardiovascular events . One hundred and fifty‐four patients had a second sAF measurement 4 years later.…”

Ethnicity and skin autofluorescence-based risk-engines for cardiovascular disease and diabetes mellitus

“…In situations of metabolic and oxidative stress, however, accelerated AGE accumulation rates have been described, such as in individuals with cardiovascular disease (CVD) [ 1 , 2 ] and diabetes mellitus (DM) [ 3 , 4 ]. The fairly quick (seconds) and non-invasive assessment of skin autofluorescence (SAF) has been demonstrated to serve as a surrogate marker of tissue accumulation of AGEs [ 5 , 6 ] and recent efforts have been undertaken to develop stratification tools for the clinical assessment of a patient's risk for cardiovascular disease (CVD) [ 7 – 9 ] and diabetic complications [ 10 – 12 ].…”