Increased skin autofluorescence of children and adolescents with type 1 diabetes despite a well-controlled HbA1c: results from a cohort study.
BACKGROUND
Early identification of children and adolescents with type 1 diabetes at high risk for development of complications is important, as early intervention may prevent further deterioration. Here we investigate the applicability of assessing skin advanced glycation end products (sAGEs) by skin autofluorescence (SAF) as a potential surrogate risk marker.


METHODS
This study included a cross-sectional analysis of SAF in 77 patients with type 1 diabetes mellitus and 118 healthy controls across age categories (11-12, 13-14, 15-16, and 17-19 years old). In patients, the impact of current and historical glycated hemoglobin (HbA1c) values, age, and duration of diabetes on SAF was studied in a retrospective cohort study and analyzed with multivariable analyses.


RESULTS
SAF was significantly and similarly higher in patients when compared with controls across all age categories (P ≤0.009). For patients, age, duration of diabetes, and current and historical HbA1c were associated with SAF in univariate analysis. Multivariate analysis showed no association between HbA1c and SAF. A subgroup of patients with a HbA1c-within-target (≤7.5 %/59 mmol/mol) were observed to have high SAF.


CONCLUSIONS
Children and adolescents with type 1 diabetes show higher SAF than controls. The presumed correlation of high HbA1c with high SAF does not exist in all patients. Thus, use of this non-invasive measure may provide a surrogate marker for diabetic complications, additional to HbA1c.
Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011, TA, Rotterdam, Netherlands. j.vanderheyden@sfvg.nl.|Department of Pediatric Endocrinology, Sophia Children's Hospital, Erasmus MC, University Medical Centre, Wytemaweg 80, 3015, CN, Rotterdam, Netherlands. j.vanderheyden@sfvg.nl.|Department of Pediatrics, Sint Franciscus Gasthuis, Kleiweg 500, 3045, PM, Rotterdam, Netherlands. j.vanderheyden@sfvg.nl.
Josine C
JC
van der Heyden
Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011, TA, Rotterdam, Netherlands.|Department of Genetics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, Netherlands.
Erwin
E
Birnie
Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011, TA, Rotterdam, Netherlands.
Dick
D
Mul
Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011, TA, Rotterdam, Netherlands.
Sarah
S
Bovenberg
Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011, TA, Rotterdam, Netherlands.
Henk J
HJ
Veeze
Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011, TA, Rotterdam, Netherlands.
Henk-Jan
HJ
Aanstoot
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis*; D042241:Early Diagnosis; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D017127:Glycation End Products, Advanced / Q000032:analysis*; D006801:Humans; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D061848:Optical Imaging; D012307:Risk Factors; D012867:Skin / Q000378:metabolism*
D015415:Biomarkers; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; C517652:hemoglobin A1c protein, human
Diabetic complications; Pediatrics; Skin advanced glycation end products; Skin autofluorescence; Type 1 diabetes