Skin Autofluorescence as a Noninvasive Marker of Vascular Damage in Patients With Type 2 Diabetes

Abstract

OBJECTIVE—Advanced glycation end products (AGEs) are thought to have a role in the pathogenesis of diabetes complications. We recently reported the association between skin autofluorescence, as a measure of tissue AGE accumulation, and diabetic neuropathy in a selected diabetic population. In this study, we investigated the relation between skin autofluorescence and clinical variables including micro- and macrovascular complications in a type 2 diabetes primary care population. RESEARCH DESIGN AND METHODS—Clinical data and skin autofluorescence were obtained in the type 2 diabetes group (n = 973) and in a control group (n = 231). Skin autofluorescence was assessed by illumination of the lower arm with a fluorescent tube (peak intensity ∼370 nm). RESULTS—Skin autofluorescence was significantly higher in type 2 diabetic patients compared with control subjects in each age category. Multiple regression analysis showed significant correlation of skin autofluorescence with age, sex, diabetes duration, BMI, smoking, HbA1c, plasma creatinine, HDL cholesterol, and albumin-to-creatinine ratio in the type 2 diabetes group (R2 = 25%) and with age and smoking in the control group (R2 = 46%). Skin autofluorescence was significantly higher in the type 2 diabetes group, with both micro- and macrovascular disease, compared with the group without complications and the group with only microvascular complications. CONCLUSIONS—This study confirms in a large group of type 2 diabetic patients that skin autofluorescence is higher compared with age-matched control subjects and is associated with the severity of diabetes-related complications. Skin autofluorescence reflecting vascular damage might be a rapid and helpful tool in the diabetes outpatient clinic for identifying diabetic patients who are at risk for developing complications.

In vivo time-resolved autofluorescence measurements to test for glycation of human skin

“…The study's primary focus was monitoring disease progression and evaluating the patient's risk for diabetic complications. In a later study, the same group showed that autofluorescence also correlated with severity of diabetic neuropathy [34] and vascular damage in type 2 diabetic subjects [35]. However, the effect of skin color was not addressed in these studies as nearly all subjects recruited were Caucasian.…”

“…However, the effect of skin color was not addressed in these studies as nearly all subjects recruited were Caucasian. In fact, the researchers reported that data from dark-skinned subjects had to be discarded, because of nearly complete absorption of excitation light by the skin [35]. Otherwise, the steady-state measurements would need to be adjusted to account for skin complexion.…”

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

“…Cross-sectional data showed that smoking resulted in increased skin AF levels in both T2DM and controls, but in the present longitudinal analyses, smoking at baseline did not correlate to skin AF levels at follow-up. 7 This could be because of the short follow-up period and/or the strict diabetes treatment regimen of patients participating in the shared care project, which included stimulation of patients to stop smoking. The percentage of smokers was low in our cohort.…”

Skin Autofluorescence and All-Cause Mortality in Stage 3 CKD

“…Skin AF measurement has been validated against levels of specific AGE molecules in patients with diabetes and CKD and healthy controls (14)(15)(16)(17)(18). Increased skin AF is associated with AGE accumulation and development of a range of vascular complications as well as allcause and cardiovascular mortality in people with diabetes (14)(15)(16)(17)(18). In people with end-stage kidney disease on dialysis, skin AF is associated with arterial stiffness (19).…”