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

¹ Department of Medicine, University Medical Center Groningen, Groningen, the Netherlands
² Department of Medicine, Isala Clinics, Zwolle, the Netherlands
³ Department of Biomedical Engineering, University Medical Center Groningen, Groningen, the Netherlands
⁴ Family practice ‘t Veen, Hattem, the Netherlands

Address correspondence and reprint requests to Helen L. Lutgers, Department of Medicine U3.129, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, Netherlands. E-mail: h.l.lutgers{at}isala.nl

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, HbA_1c, 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.

Abbreviations: AFR, autofluorescence reader • AGE, advanced glycation end product • ASA, American Society of Anesthesiologists • CLF, collagen-linked fluorescence • Hb-AGE, hemoglobin linked to AGE • LMW-AGE, low–molecular weight AGE

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