The Association Between Skin Autofluorescence and Vascular Complications in Chinese Patients With Diabetic Foot Ulcer

Abstract

The tissue accumulation of advanced glycation end products (AGEs) can be noninvasively assessed as skin autofluorescence (SAF) by the AGE Reader(TM) device. We aimed to detect the association between SAF and diabetes-associated vascular complications in diabetic foot ulcer (DFU) patients engaged in this study. This cross-sectional survey consisted of 118 consecutive hospitalized diabetic foot patients. The diabetic microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular referring to coronary heart disease (CHD), cerebrovascular disease (CVD), or peripheral artery disease (PAD) complications were evaluated, and then they were divided into different subgroups based on the assessment of vascular complications. As seen from the results, the mean SAF value was 2.8 ± 0.2 AU. SAF was significantly associated with diabetes duration and blood urea nitrogen (R(2) = 62.8%; P < .01). Moreover, in logistic regression analysis, SAF was significantly associated with retinopathy (odds ratio [OR] = 40.11), nephropathy (OR = 8.44), CHD (OR = 44.31), CVD (OR = 80.73), and PAD (OR = 5.98 × 10(9)). In conclusion, SAF, reflecting tissue accumulation of AGEs, is independently associated with the presence of vascular complications in DFU patients.

Association between diabetic foot ulcer and diabetic retinopathy

“…The differences in the prevalence in DR between the two studies could be caused in part by differences in DFU severity, as our study included patients with higher DFU grades (grades 4 and 5). Jiang et al[18] and Liu et al[19] reported the prevalence of DR as 40.9% and 21.2%, respectively, in patients with DFU; however, both studies involved younger patients with shorter diabetes durations than in our study. Another difference was that in these two studies, serum creatinine levels were 0.91 and 0.76 mg/dL, respectively, which were lower than that in our study (3.0 mg/dL).…”

Oxidative stress and antioxidant treatment in patients with peripheral artery disease

“…AGEs have been shown to be elevated in the serum of type 2 diabetic patients with PAD, with a simultaneous reduction in antioxidant status (Lapolla et al 2007). Other studies have used skin autofluorescence (SAF) as a non-invasive measurement of tissue AGE accumulation, and SAF has been reported to be significantly increased in PAD patients (Noordzij et al 2012;Liu et al 2015a;de Vos et al 2016). Additionally, in a 5-year prospective cohort study, higher SAF was independently associated with increased risk for all-cause mortality and fatal or nonfatal major adverse cardiovascular events (de Vos et al 2014), and SAF was a predictor for amputation in patients with PAD independent from the presence of DM and Fontaine stage (de Vos et al 2015).…”

Skin autofluorescence, a non-invasive marker of advanced glycation end products: clinical relevance and limitations

“…Most publications reporting other ethnic groups included East Asian subpopulations, predominantly from Japan or China 31 42 43. Therefore, it is essential to assess SAF levels in dark skinned subjects since they are the most prevalent skin type of the world and represent the group with highest incidence of diabetes 44.…”