Skin autofluorescence provides additional information to the UK Prospective Diabetes Study (UKPDS) risk score for the estimation of cardiovascular prognosis in type 2 diabetes mellitus.
OBJECTIVE
The UK Prospective Diabetes Study (UKPDS) risk engine has become a standard for cardiovascular risk assessment in type 2 diabetes mellitus. Skin autofluorescence was recently introduced as an alternative tool for cardiovascular risk assessment in diabetes. We investigated the prognostic value of skin autofluorescence for cardiovascular events in combination with the UKPDS risk engine in a cohort of patients with type 2 diabetes managed in primary care.


METHODS
Clinical, UKPDS risk engine and skin autofluorescence data were obtained at baseline in 2001-2002 in the type 2 diabetes group (n = 973). Follow-up data concerning fatal and non-fatal cardiovascular events (primary endpoint) were obtained till 2005. Patients were classified as 'low risk' when their 10 year UKPDS risk score for fatal cardiovascular events was <10%, and 'high risk' if >10%. Skin autofluorescence was measured non-invasively with an autofluorescence reader. Skin autofluorescence was classified by the median (i.e. low risk < median, high risk > median).


RESULTS
The incidence of cardiovascular events was 119 (44 fatal, 75 non-fatal). In multivariate analysis, skin autofluorescence, age, sex and diabetes duration were predictors for the primary endpoint. Addition of skin autofluorescence information to that from the UKPDS risk engine resulted in re-classification of 55 of 203 patients from the low-risk to the high-risk group. The 10 year cardiovascular event rate was higher in patients with a UKPDS score >10% when skin autofluorescence was above the median (55.8% vs 38.9%).


CONCLUSIONS
Skin autofluorescence provides additional information to the UKPDS risk engine which can result in risk re-classification of a substantial number of patients. It furthermore identifies patients who have a particularly high risk for developing cardiovascular events.
Lutgers
H L
HL
Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands. h.l.lutgers@int.umcg.nl
Gerrits
E G
EG
Graaff
R
R
Links
T P
TP
Sluiter
W J
WJ
Gans
R O
RO
Bilo
H J
HJ
Smit
A J
AJ
D000368:Aged; D000704:Analysis of Variance; D001132:Arm / Q000528:radiation effects; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000473:pathology*; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D005260:Female; D005453:Fluorescence; D006442:Glycated Hemoglobin / Q000378:metabolism; D017127:Glycation End Products, Advanced / Q000378:metabolism; D006801:Humans; D008027:Light; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010821:Physicians, Family; D011379:Prognosis; D018570:Risk Assessment; D012867:Skin / Q000528:radiation effects*; D006113:United Kingdom
D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced