title: Skin autofluorescence and risk of micro- and macrovascular complications in patients with Type 2 diabetes mellitus-a multi-centre study.
abstract: OBJECTIVE
  Skin autofluorescence is a non-invasive marker of advanced glycation end product accumulation. In a previous study, skin autofluorescence correlated with and predicted micro- and macrovascular complications in Type 2 diabetes in a primary care setting. The present cross-sectional study aims to confirm the association between skin autofluorescence and diabetic complications in patients with Type 2 diabetes in a multi-centre secondary care setting.
  
  
  METHODS
  We analysed 563 subjects with Type 2 diabetes mellitus from five Dutch hospitals.
  
  
  RESULTS
  Median age was 64 years, median duration of diabetes 13 years and median HbA(1c) 58 mmol/mol (7.5%). Sixty-one per cent of patients had microvascular complications (38% nephropathy, 36% retinopathy, 35% neuropathy) and 42% had macrovascular complications. Median UK Prospective Diabetes Study 10-year risk for coronary events was 19%. Median skin autofluorescence was elevated compared with age-matched healthy control subjects: 2.77 (interquartile range 2.39-3.28) vs. 2.46 (2.08-2.84) arbitrary units. Skin autofluorescence was particularly increased in patients with complications: no complications, median 2.56 (2.26-2.90); microvascular complications, 2.79 (2.38-3.29); macrovascular complications, 2.85 (2.41-3.41); both micro- and macrovascular complications, 2.96 (2.56-3.60) arbitrary units, P < 0.001. Logistic regression analysis showed that age, duration of diabetes, renal function, gender, atrial fibrillation and skin autofluorescence were independently associated with macrovascular complications. Multiple regression analysis identified age, smoking, renal function, macrovascular complications and the number of microvascular complications as the determinants of skin autofluorescence.
  
  
  CONCLUSIONS
  This study confirms that skin autofluorescence is increased in patients with Type 2 diabetes in a secondary care setting. Skin autofluorescence was associated with macrovascular complications in patients with diabetes and this association was independent of classical risk factors.
authors.affiliation: Department of Internal Medicine, University of Groningen, Groningen, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Noordzij
authors.forename: D J
authors.initials: DJ
authors.lastname: Mulder
authors.forename: P H N
authors.initials: PH
authors.lastname: Oomen
authors.forename: T
authors.initials: T
authors.lastname: Brouwer
authors.forename: J
authors.initials: J
authors.lastname: Jager
authors.forename: M
authors.initials: M
authors.lastname: Castro Cabezas
authors.forename: J D
authors.initials: JD
authors.lastname: Lefrandt
authors.forename: A J
authors.initials: AJ
authors.lastname: Smit
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000737:chemistry; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000378:metabolism* / Q000517:prevention & control; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000378:metabolism* / Q000517:prevention & control; D005260:Female; D005453:Fluorescence; D017127:Glycation End Products, Advanced / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015203:Reproducibility of Results; D012307:Risk Factors; D012867:Skin / Q000098:blood supply / Q000737:chemistry*
chemical_list: D015415:Biomarkers; D017127:Glycation End Products, Advanced