Clinical significance of skin autofluorescence for diabetic macroangiopathy and comparison with conventional markers of atherosclerosis: a cross-sectional and prospective study

Ema Aoki; Takeshi Hirashima; Yuko Kumamoto; Yuko Yamamoto; Natsuko Suzuki; Taito Oshima; Daizo Saito; Tsutomu Hirano

doi:10.1007/s13340-022-00608-8

Clinical significance of skin autofluorescence for diabetic macroangiopathy and comparison with conventional markers of atherosclerosis: a cross-sectional and prospective study

Diabetol Int. 2022 Nov 28;14(2):145-154. doi: 10.1007/s13340-022-00608-8. eCollection 2023 Apr.

Authors

Ema Aoki^#¹, Takeshi Hirashima^#¹, Yuko Kumamoto², Yuko Yamamoto², Natsuko Suzuki¹, Taito Oshima¹, Daizo Saito³, Tsutomu Hirano¹

Affiliations

¹ Diabetes Center, Ebina General Hospital, Kawaharaguchi 1320, Ebina, Kanagawa 243-0433 Japan.
² Department of Clinical Laboratory, Ebina General Hospital, Ebina, Japan.
³ Department of Nutrition, Ebina General Hospital, Ebina, Japan.

^# Contributed equally.

Abstract

Background: Skin autofluorescence (SAF) is a marker for the accumulation of advanced glycation end products (AGEs), and is associated with diabetic macroangiopathy. However, whether SAF is superior to conventional markers of atherosclerosis such as carotid intima-media thickness (IMT) and pulse wave velocity (PWV) in detecting macroangiopathy remains unclear.

Methods: We recruited 845 patients with type 2 diabetes enrolled in a community diabetes cohort (ViNA cohort) who had SAF, IMT, and PWV measured at baseline. The prevalence of macroangiopathy at baseline and new cardiovascular events during the 2-year follow-up period was investigated. SAF was measured using an AGE reader. Coronary artery calcification (CAC) was measured by computed tomography in 485 patients. Peripheral artery disease (PAD) was defined as the ankle-brachial blood pressure ratio of ≤ 0.9.

Results: SAF, IMT, and PWV were significantly correlated with each other, and age, diabetes duration, and estimated glomerular filtration rate were their strong confounders. SAF was associated with baseline stroke and new stroke after adjusting for confounders, but not with coronary artery disease (CAD) or PAD. The nonsignificant relationship between SAF and CAD was consistent with the relationship between SAF and CAC. Multivariate analysis showed a significant association of SAF with baseline and new stroke independent of IMT and PWV. Maximum-IMT was significantly associated with baseline CAD, PAD, and stroke, but not with a new stroke, whereas PWV was associated with a new stroke.

Conclusion: Among diabetic macroangiopathies, SAF is a good stroke biomarker, but not for CAD and PAD.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-022-00608-8.

Keywords: Advanced glycation end-products; Atherosclerosis; Diabetic macroangiopathy; Skin autofluorescence; Surrogate markers.

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