The Association of Skin-Intrinsic Fluorescence With Type 1 Diabetes Complications in the DCCT/EDIC Study
- Trevor J. Orchard, MD1⇑,
- Timothy J. Lyons, MD2,
- Patricia A. Cleary, MS3,
- Barbara H. Braffett, PHD3,
- John Maynard, MS4,
- Catherine Cowie, PHD5,
- Rose A. Gubitosi-Klug, MD, PHD6,
- Jeff Way, BS4,
- Karen Anderson, MS3,
- Annette Barnie, RN, CDE7,
- Stephan Villavicencio, MS3,
- the DCCT/EDIC Research Group*
- 1University of Pittsburgh, Pittsburgh, Pennsylvania
- 2University of Oklahoma, Oklahoma City, Oklahoma
- 3George Washington University, Rockville, Maryland
- 4VeraLight, Inc, Albuquerque, New Mexico
- 5National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
- 6University Hospitals Case Medical Center, Cleveland, Ohio
- 7University of Toronto, Toronto, Ontario, Canada
- Corresponding author: Trevor Orchard, .
OBJECTIVES To determine whether skin-intrinsic fluorescence (SIF) is associated with long-term complications of type 1 diabetes (T1D) and, if so, whether it is independent of chronic glycemic exposure and previous intensive therapy.
RESEARCH DESIGN AND METHODS We studied 1,185 (92%) of 1,289 active Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) participants from 2010 to 2011. SIF was determined using a fluorescence spectrometer and related cross-sectionally to recently determined measures of retinopathy (stereo fundus photography), cardiac autonomic neuropathy (CAN; R-R interval), confirmed clinical neuropathy, nephropathy (albumin excretion rate [AER]), and coronary artery calcification (CAC).
RESULTS Overall, moderately strong associations were seen with all complications, before adjustment for mean HbA1c over time, which rendered these associations nonsignificant with the exception of sustained AER >30 mg/24 h and CAC, which were largely unaffected by adjustment. However, when examined within the former DCCT treatment group, associations were generally weaker in the intensive group and nonsignificant after adjustment, while in the conventional group, associations remained significant for CAN, sustained AER >30 mg/24 h, and CAC even after mean HbA1c adjustment.
CONCLUSIONS SIF is associated with T1D complications in DCCT\EDIC. Much of this association appears to be related to historical glycemic exposure, particularly in the previously intensively treated participants, in whom adjustment for HbA1c eliminates statistical significance.
↵* A complete list of participants in the DCCT/EDIC Research Group can be found at http://www.nejm.org/doi/full/10.1056/NEJMoa1111732#t=articleResults (N Engl J Med 2011;365:2366–2376).
- Received December 20, 2012.
- Accepted April 26, 2013.
- © 2013 by the American Diabetes Association.
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