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Skin Autofluorescence

A tool to identify type 2 diabetic patients at risk for developing microvascular complications

¹ Diabetes Centre, Isala Clinics, Zwolle, the Netherlands
² Department of Medicine, University Medical Centre Groningen, Groningen, the Netherlands
³ Langerhans Medical Research Group, Zwolle, the Netherlands
⁴ Department of Biomedical Engineering, University Medical Centre Groningen, Groningen, the Netherlands
⁵ Department of General Practice, University Medical Centre Groningen and University of Groningen, Groningen, the Netherlands
⁶ Department of Medicine, University of Groningen, Groningen, the Netherlands

Address correspondence and reprint requests to Esther G. Gerrits, Diabetes Centre, Isala Clinics, Zwolle, P.O. Box 10400, 8000 GK Zwolle, Netherlands. E-mail: e.g.gerrits{at}isala.nl

OBJECTIVE—Skin autofluorescence is a noninvasive measure of the level of tissue accumulation of advanced glycation end products, representing cumulative glycemic and oxidative stress. Recent studies have already shown a relationship between skin autofluorescence and diabetes complications, as well as the predictive value of skin autofluorescence for total and cardiovascular mortality in type 2 diabetes. Our aim was to investigate the predictive value of skin autofluorescence for the development of microvascular complications in type 2 diabetes.

RESEARCH DESIGN AND METHODS—At baseline, skin autofluorescence of 973 type 2 diabetic patients with well-controlled diabetes was noninvasively measured with an autofluorescence 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 end points were the development of diabetes-associated retinopathy, neuropathy, and (micro)albuminuria.

RESULTS—After a mean follow-up period of 3.1 years, baseline skin autofluorescence was significantly higher in patients who developed any microvascular complication, neuropathy, or (micro)albuminuria but not in those who developed retinopathy. Multivariate analyses showed skin autofluorescence as a predictor for development of any microvascular complication along with A1C, for development of neuropathy along with smoking, and for development of (micro)albuminuria together with sex, A1C, and diabetes duration. Skin autofluorescence did not have predictive value for the development of retinopathy, albeit diabetes duration did.

CONCLUSIONS—Our study is the first observation of skin autofluorescence measurement as an independent predictor of development of microvascular complications in type 2 diabetes.

Abbreviations: AGE, advanced glycation end product • DCCT, Diabetes Control and Complications Trial • UKPDS, UK Prospective Diabetes Study

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