Skin Autofluorescence Reflects Integration of Past Long-Term Glycemic Control in Patients With Type 1 Diabetes

Abstract

OBJECTIVEThe aim was to investigate the relationships between skin autofluorescence (AF) and the impact of past glycemic control and microvascular complications in Japanese patients with type 1 diabetes.RESEARCH DESIGN AND METHODSTwo hundred forty-one patients and 110 controls were enrolled. Advanced glycation end product accumulation was measured with AF reader. Three monthly HbA1c levels during the past 20 years were determined from medical records, and the HbA1c area under the curve (AUC) was calculated. We performed multivariate regression analyses to examine the associations between the severity of diabetes complications and various variables.RESULTSSkin AF values increased with increasing the severity of retinopathy (P < 10−11, linear regression analysis) and nephropathy (P < 10−5 for chronic kidney disease stage; P < 10−5 for albuminuria-based stage). HbA1c AUC values over the past 15 years were significantly correlated with skin AF values (past 5 years: R = 0.35, P < 0.0001; past 10 years: R = 0.36, P < 0.0001; past 15 years: R = 0.55, P < 0.0001; past 20 years: R = 0.22, P = 0.13). HbA1c AUC values over the past 3, 5, 10, and 15 years were significantly associated with the severity of both nephropathy and retinopathy. Multivariate analyses in which HbA1c AUC value was removed from the independent variables indicated that only skin AF was independently associated with nephropathy, whereas age at registration, age at onset of diabetes, and skin AF were independently associated with retinopathy.CONCLUSIONSSkin AF reflects past long-term glycemic control and may serve as a surrogate marker for the development of microvascular complications in place of HbA1c AUC value.

Association of advanced glycation end products and chronic kidney disease with macroangiopathy in type 2 diabetes

“…Diabetes (Sugisawa et al, 2013). As a marker of metabolic memory, sAF may be especially interesting in patients with Type 2 Diabetes (T2D) (Lutgers et al, 2006), whose duration and previous glucose control are often uncertain.…”

A bőr-autofluoreszcencia és a konvencionális glykaemiás markerek kapcsolata diabeteses betegekben

“…Más vizsgálók gyenge pozitív korrelációt észleltek az aktuális HbA 1c és a SAF szintjei között, de az elmúlt 3-15 év HbA 1c -adataiból származtatható AUC értékeit tekintve szignifi káns korrelációt találtak (n = 200; p<0,0001) T1DM-páciensekben a bőrautofl uoreszcencia-eredmé-nyekkel. Ugyancsak összefüggött a SAF a diabeteses retinopathia súlyosságával és a nephropathia előrehaladott-sági fokával [12].…”

Optical and structural properties of biological tissues under diabetes mellitus

“…The skin fluorescence can reflect the age-related changes, the kidney diseases, as well as the changes induced by smoking [126]. The skin autofluorescence enhancement was observed in diabetic patients with retinopathy and nephropathy [127]. The excitation light wavelength varied from 300 to 420 nm with the peak excitation at 370 nm.…”

“…The excitation light wavelength varied from 300 to 420 nm with the peak excitation at 370 nm. The normalized autofluorescence signal was calculated by division of the mean radiated light intensity in the range 420-600 nm by the mean intensity of the excitation in the range 300-420 nm [127].…”