Skin autofluorescence predicts major adverse cardiovascular events in patients with type 1 diabetes: a 7-year follow-up study

Abstract

BackgroundAdvanced glycation end-products play a role in diabetic vascular complications. Their optical properties allow to estimate their accumulation in tissues by measuring the skin autofluorescence (SAF). We searched for an association between SAF and major adverse cardiovascular events (MACE) incidence in subjects with Type 1 Diabetes (T1D) during a 7 year follow-up.MethodsDuring year 2009, 232 subjects with T1D were included. SAF measurement, clinical [age, sex, body mass index (BMI), comorbidities] and biological data (HbA1C, blood lipids, renal parameters) were recorded. MACE (myocardial infarction, stroke, lower extremity amputation or a revascularization procedure) were registered at visits in the center or by phone call to general practitioners until 2016.ResultsThe participants were mainly men (59.5%), 51.5 ± 16.7 years old, with BMI 25.0 ± 4.1 kg/m2, diabetes duration 21.5 ± 13.6 years, HbA1C 7.6 ± 1.1%. LDL cholesterol was 1.04 ± 0.29 g/L, estimated Glomerular Filtration Rates (CKD-EPI): 86.3 ± 26.6 ml/min/1.73 m2. Among these subjects, 25.1% were smokers, 45.3% had arterial hypertension, 15.9% had elevated AER (≥ 30 mg/24 h), and 9.9% subjects had a history of previous MACE. From 2009 to 2016, 22 patients had at least one new MACE: 6 myocardial infarctions, 1 lower limb amputation, 15 revascularization procedures. Their SAF was 2.63 ± 0.73 arbitrary units (AU) vs 2.08 ± 0.54 for other patients (p = 0.002). Using Cox-model, after adjustment for age (as the scale time), sex, diabetes duration, BMI, hypertension, smoking status, albumin excretion rates, statin treatment and a previous history of MACE, higher baseline levels of SAF were significantly associated with an increased risk of MACE during follow-up (HR = 4.13 [1.30–13.07]; p = 0.02 for 1 AU of SAF) and Kaplan–Meier curve follow-up showed significantly more frequent MACE in group with SAF upper the median (p = 0.001).ConclusionA high SAF predicts MACE in patients with T1D.Electronic supplementary materialThe online version of this article (10.1186/s12933-018-0718-8) contains supplementary material, which is available to authorized users.

Skin autofluorescence, a marker of glucose memory in type 2 diabetes

“…They are also major contributors for vascular diabetic complications in T2D [ 19 ]. The relations between SAF and these complications, as already reported for T1D [ 20 , 21 ] were therefore expected. Numerous studies have reported high sAF in complicated T2D [ 16 , [22] , [23] , [24] ].…”

Risk of early mortality and cardiovascular disease in type 1 diabetes: a comparison with type 2 diabetes, a nationwide study

“…The proportional hazard assumption of the Cox models was ensured by the Schoenfeld residuals. Regression models were constructed to include various risk factors for CVD as potential confounders, referring to previous reports [19, 30–38]. Model 1 was adjusted for age and sex.…”

Skin Autofluorescence, a Noninvasive Biomarker for Advanced Glycation End-Products, Is Associated With Prevalent Vertebral and Major Osteoporotic Fractures: The Rotterdam Study

“…Skin fluorescence has also been evaluated as a clinical tool for noninvasive assessment of AGEs in tissues and associated with long-term complications of diabetes. (31,32) Participants were instructed not to apply any lotion or creams on the dominant forearm for 2 days prior to the measurement. The AGE Reader illuminates 4 cm 2 of skin on the dominant forearm with an excitation light source with a peak wavelength at 370 nm.…”