Skin Autofluorescence Based Decision Tree in Detection of Impaired Glucose Tolerance and Diabetes

Abstract

AimDiabetes (DM) and impaired glucose tolerance (IGT) detection are conventionally based on glycemic criteria. Skin autofluorescence (SAF) is a noninvasive proxy of tissue accumulation of advanced glycation endproducts (AGE) which are considered to be a carrier of glycometabolic memory. We compared SAF and a SAF-based decision tree (SAF-DM) with fasting plasma glucose (FPG) and HbA1c, and additionally with the Finnish Diabetes Risk Score (FINDRISC) questionnaire±FPG for detection of oral glucose tolerance test (OGTT)- or HbA1c-defined IGT and diabetes in intermediate risk persons.MethodsParticipants had ≥1 metabolic syndrome criteria. They underwent an OGTT, HbA1c, SAF and FINDRISC, in adition to SAF-DM which includes SAF, age, BMI, and conditional questions on DM family history, antihypertensives, renal or cardiovascular disease events (CVE).Results218 persons, age 56 yr, 128M/90F, 97 with previous CVE, participated. With OGTT 28 had DM, 46 IGT, 41 impaired fasting glucose, 103 normal glucose tolerance. SAF alone revealed 23 false positives (FP), 34 false negatives (FN) (sensitivity (S) 68%; specificity (SP) 86%). With SAF-DM, FP were reduced to 18, FN to 16 (5 with DM) (S 82%; SP 89%). HbA1c scored 48 FP, 18 FN (S 80%; SP 75%). Using HbA1c-defined DM-IGT/suspicion ≥6%/42 mmol/mol, SAF-DM scored 33 FP, 24 FN (4 DM) (S76%; SP72%), FPG 29 FP, 41 FN (S71%; SP80%). FINDRISC≥10 points as detection of HbA1c-based diabetes/suspicion scored 79 FP, 23 FN (S 69%; SP 45%).ConclusionSAF-DM is superior to FPG and non-inferior to HbA1c to detect diabetes/IGT in intermediate-risk persons. SAF-DM’s value for diabetes/IGT screening is further supported by its established performance in predicting diabetic complications.

Tissue intrinsic fluorescence recovering by an empirical approach based on the PSO algorithm and its application in type 2 diabetes screening

“…Skin autofluorescence (SAF) is a noninvasive proxy of tissue accumulation of advanced glycation end products (AGE) which is considered to be a carrier of glycometabolic memory [21]. While the detected skin autofluorescence spectrum is heavily distorted due to emitted fluorescence being absorbed and scattered within the sample, and furthermore, the propagation of the excitation light is affected by the background absorption and scattering, they result in that the detected autofluorescence may not be proportional to fluorophore concentration.…”

Glükózterhelés a peritonealis dialízisben. Újabb elméleti megfontolások

“…Az elmúlt 10 évben elterjedtté vált a bőrben lerakódott, fluoreszcenciát mutató glikációs végtermékek noninvazív mérése dializált betegekben [29], amely általános diabeteses betegcsoportban mind a macro-, mind a microvascularis szövődményekkel korrelált [30], sőt a diabe-tes szűrésére is alkalmasnak bizonyult [31]. Különböző mérőeszközök állnak rendelkezésre, amelyek közös mé-rési módszere, hogy a subcutisban lévő fluoreszcens molekulák által emittált 420-600 nm közé eső fény intenzitását egy 300-420 nm közé eső gerjesztőfény intenzitá-sára vonatkoztatott százalékban fejezik ki [32].…”

Correction for tissue optical properties enables quantitative skin fluorescence measurements using multi-diameter single fiber reflectance spectroscopy

“…The combined emission of these fluorophores constitutes the skin autofluorescence, and higher levels are correlated with cardiovascular events, diabetes mellitus, chronic pulmonary disease, renal disease, liver cirrhosis and inflammatory diseases [5][6][7][8][9][10][11]. Fluorescence spectroscopy can also be used to measure protoporphyrin IX (PpIX) concentrations during photodynamic therapy (PDT).…”