Higher skin autofluorescence in young people with Type 1 diabetes and microvascular complications

Diabet Med. 2017 Apr;34(4):543-550. doi: 10.1111/dme.13280. Epub 2016 Nov 18.

Abstract

Aim: To test the hypothesis that non-invasive skin autofluorescence, a measure of advanced glycation end products, would provide a surrogate measure of long-term glycaemia and be associated with early markers of microvascular complications in adolescents with Type 1 diabetes.

Methods: Forearm skin autofluorescence (arbitrary units) was measured in a cross-sectional study of 135 adolescents with Type 1 diabetes [mean ± sd age 15.6 ± 2.1 years, diabetes duration 8.7 ± 3.5 years, HbA1c 72 ± 16 mmol/mol (8.7 ± 1.5%)]. Retinopathy, assessed using seven-field stereoscopic fundal photography, was defined as ≥1 microaneurysm or haemorrhage. Cardiac autonomic function was measured by standard deviation of consecutive RR intervals on a 10-min continuous electrocardiogram recording, as a measure of heart rate variability.

Results: Skin autofluorescence was significantly associated with age (R2 = 0.15; P < 0.001). Age- and gender-adjusted skin autofluorescence was associated with concurrent HbA1c (R2 = 0.32; P < 0.001) and HbA1c over the previous 2.5-10 years (R2 = 0.34-0.43; P < 0.002). Age- and gender-adjusted mean skin autofluorescence was higher in adolescents with retinopathy vs those without retinopathy [mean 1.38 (95% CI 1.29, 1.48) vs 1.22 (95% CI 1.17, 1.26) arbitrary units; P = 0.002]. In multivariable analysis, retinopathy was significantly associated with skin autofluorescence, adjusted for duration (R2 = 0.19; P = 0.03). Cardiac autonomic dysfunction was also independently associated with skin autofluorescence (R2 = 0.11; P = 0.006).

Conclusions: Higher skin autofluorescence is associated with retinopathy and cardiac autonomic dysfunction in adolescents with Type 1 diabetes. The relationship between skin autofluorescence and previous glycaemia may provide insight into metabolic memory. Longitudinal studies will determine the utility of skin autofluorescence as a non-invasive screening tool to predict future microvascular complications.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Autonomic Nervous System Diseases / etiology
  • Autonomic Nervous System Diseases / physiopathology
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / metabolism
  • Diabetes Mellitus, Type 1 / physiopathology*
  • Diabetic Angiopathies / diagnostic imaging*
  • Diabetic Angiopathies / etiology
  • Diabetic Angiopathies / physiopathology
  • Diabetic Retinopathy / diagnostic imaging*
  • Diabetic Retinopathy / etiology
  • Diabetic Retinopathy / physiopathology
  • Electrocardiography
  • Female
  • Fundus Oculi
  • Glycated Hemoglobin A / metabolism
  • Heart Rate
  • Humans
  • Male
  • Microaneurysm / diagnostic imaging*
  • Microaneurysm / etiology
  • Microaneurysm / physiopathology
  • Multivariate Analysis
  • Optical Imaging
  • Retinal Hemorrhage / diagnostic imaging*
  • Retinal Hemorrhage / etiology
  • Retinal Hemorrhage / physiopathology
  • Skin / blood supply
  • Skin / diagnostic imaging*

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human