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Diabetes Care 30:107-112, 2007
DOI: 10.2337/dc06-1391
© 2007 by the American Diabetes Association
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Cardiovascular and Metabolic Risk
Original Article

Skin Autofluorescence Is a Strong Predictor of Cardiac Mortality in Diabetes

Robbert Meerwaldt, MD, PHD1, Helen L. Lutgers, MD1, Thera P. Links, MD, PHD1, Reindert Graaff, MSC, PHD2, John W. Baynes, PHD3, Rijk O.B. Gans, MD, PHD1 and Andries J. Smit, MD, PHD1

1 Department of Medicine, University Medical Center Groningen, Groningen, the Netherlands
2 Department of Biomedical Engineering, University Medical Center Groningen, Groningen, the Netherlands
3 Department of Chemistry and Biochemistry, University of South Carolina, Columbia, South Carolina

Address correspondence and reprint requests to Andries J. Smit, Department of Medicine U3.129, University Medical Center Groningen, Hanzeplein 1 9700 RB Groningen, Netherlands. E-mail: a.j.smit{at}chir.umcg.nl

OBJECTIVE—Advanced glycation end products (AGEs) are biomarkers of metabolic stress and are thought to contribute to the increase of coronary heart disease (CHD) in diabetes. Tissue autofluorescence is related to the accumulation of AGEs. The aim of the present study was to evaluate the relationship between skin autofluorescence and metabolic burden (hyperglycemia and hyperlipidemia) and its relationship with CHD and mortality.

RESEARCH DESIGN AND METHODS—Skin autofluorescence was measured noninvasively with an autofluorescence reader in 48 type 1 and 69 type 2 diabetic patients and 43 control subjects. The presence of CHD was observed at baseline and mortality during a follow-up period of 5 years.

RESULTS—Autofluorescence correlated with mean A1C, triglycerides, and LDL. Autofluorescence values further increased with age, microalbuminuria, dialysis treatment, and diabetes duration. Autofluorescence was strongly related to the presence of CHD (odds ratio 7.9) and predicted mortality (3.0). Multivariate analysis showed that autofluorescence was more strongly associated with CHD and mortality compared with A1C, triglycerides, and LDL.

CONCLUSIONS—Skin autofluorescence is strongly related to cumulative metabolic burden. Skin autofluorescence seems strongly associated with cardiac mortality and may provide important clinical information for risk assessment.

Abbreviations: AFR, autofluorescence reader • AGE, advanced glycation end product • ALE, advanced lipoxidation end product • CHD, coronary heart disease • CML, carboxymethyllysine


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