Abstract
Background: Skin autofluorescence (SAF) is a non-invasive marker of advanced glycation end-product (AGE) accumulation and may explain glycemic memory in diabetic patients. However, the clinical usefulness of SAF measurement is not well recognized due to its complex confounding factors. We investigated how SAF is associated with diabetic complications after adjusting for confounding factors.
Methods: Patients with type 2 diabetes (n = 1130) enrolled in the regional diabetes cohort (ViNA cohort) were examined at baseline. SAF was measured by a AGE Reader. Ankle-brachial pressure index (ABI) was measured for diagnosis of peripheral artery disease (PAD) (ABI ≤ 0.9). Diabetic kidney disease (DKD) was defined as urinary albumin-creatinine ratio ≥ 30 mg/g and estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, diabetes duration ≥ 5 years, and the presence of diabetic retinopathy. The visceral fat area (VFA) was measured by computed tomography.
Results: SAF was significantly correlated with age, duration of diabetes, and decreased eGFR. SAF was associated with diabetic retinopathy, strictly defined DKD, and stroke, but after adjusting for these confounding factors, it was no longer associated with coronary artery disease or PAD. SAF was not associated with metabolic syndrome-related risk factors, such as VFA and serum lipids.
Conclusions: SAF is affected by age, duration of diabetes, and kidney function, so careful analysis is required when assessing the clinical significance of SAF. Nevertheless, SAF is an excellent biomarker for diabetic retinopathy, DKD, and stroke.
