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Skin Autofluorescence: A Tool to Identify Type 2 Diabetic Patients at Risk for Developing Microvascular Complications

Diabetes Centre, Isala Clinics, Zwolle, the Netherlands¹
Department of Medicine, University Medical Centre Groningen, Groningen, the Netherlands²
Langerhans Medical Research Group, Zwolle, the Netherlands³
Department of Biomedical Engineering, University Medical Centre Groningen, Groningen, the Netherlands⁴
Department of General Practice, University Medical Centre Groningen and University of Groningen, Groningen, the Netherlands⁵
Department of Medicine, University of Groningen, Groningen, the Netherlands⁶

e.g.gerrits{at}isala.nl

ABSTRACT

Objective: Skin autofluorescence (AF) is a noninvasive measure of the level of tissue accumulation of advanced glycation endproducts, representing cumulative glycemic and oxidative stress. Recent studies have already shown a relationship between skin AF and diabetic complications, and its predictive value for total and cardiovascular mortality in type 2 diabetes mellitus. Our aim was to investigate the predictive value of skin AF for the development of microvascular complications in type 2 diabetes mellitus.

Research Design and Methods: At baseline, skin AF of 973 well-controlled type 2 diabetes patients was noninvasively measured with an AF reader. The aggregate clinical outcome was defined as the development of any diabetes associated microvascular complication of 881 surviving patients which was assessed at baseline and at the end of follow-up. Single endpoints were the development of diabetes associated retinopathy, neuropathy and (micro) albuminuria.

Results: After a mean follow-up period of 3.1 years, baseline skin AF was significantly higher in patients who developed any microvascular complication, neuropathy and (micro) albuminuria, but not in those who developed retinopathy. Multivariate analyses showed skin AF as a predictor for the development of any microvascular complication along with HbA1c; for the development of neuropathy along with smoking, and for the development of (micro) albuminuria together with gender, HbA_1c and diabetes duration. Skin AF did not have predictive value for the development of retinopathy, albeit diabetes duration did.

Conclusions: Our study is the first observation of skin AF measurement as an independent predictor for the development of microvascular complications in type 2 diabetes mellitus.

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