title: Skin autofluorescence, renal insufficiency and retinopathy in patients with type 2 diabetes.
abstract: OBJECTIVE
  Advanced glycation end-products (AGEs) are involved in diabetic retinopathy (DR). Their accumulation in tissues can be analyzed by measuring the skin autofluorescence (sAF). We hypothesized that renal insufficiency, another cause of high sAF, may disturb the relation between sAF and DR.
  
  
  METHODS
  We measured sAF with an AGE-Reader in 444 patients with type 2 diabetes (T2D), and we analyzed their retinal status. The associations of sAF with DR, and interaction with renal insufficiency were estimated by multivariate logistic regression analysis.
  
  
  RESULTS
  Mean age was 62years (standard deviation (SD) 10years), diabetes duration 13 (9) years and mean HbA1C 8.9% (1.8). The prevalence of DR was 21.4% and increased with age, diabetes duration, arterial hypertension, renal parameters (serum creatinine and albumin excretion rates), and sAF. The prevalence of macular edema (ME) was 8.6% and increased with the duration of diabetes, but not with sAF (p=0.11). There was a significant interaction between renal insufficiency and sAF for the relation with DR or ME (p=0.02). For the 83% patients without renal insufficiency (estimated GFR>60mL/min/1.73m2), sAF was related to DR or ME after multivariate adjustment: OR 1.87 (1.09-3.19). The 17% patients with renal insufficiency had the highest rates of DR or ME (38.6%) and the highest sAF, unrelated to each other.
  
  
  CONCLUSIONS
  In T2D patients with renal insufficiency, the high sAF does not relate to retinopathy, which should be systematically searched due to its high frequency. For other patients, a high sAF argues for DR screening.
authors.affiliation: CHU de Bordeaux, Service d'Ophtalmologie, Bordeaux, F-33000, France; CHU de Bordeaux, Department of Nutrition-Diabetology, Bordeaux, F-33000, France. Electronic address: rabia.bentata@gmail.com.
authors.forename: Rabia
authors.initials: R
authors.lastname: Bentata
authors.affiliation: Univ. Bordeaux, ISPED, F-33000 Bordeaux, France; Inserm, U1219 - Bordeaux Population Health Research Center, F-33000 Bordeaux, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Cougnard-Grégoire
authors.affiliation: CHU de Bordeaux, Service d'Ophtalmologie, Bordeaux, F-33000, France; Univ. Bordeaux, ISPED, F-33000 Bordeaux, France; Inserm, U1219 - Bordeaux Population Health Research Center, F-33000 Bordeaux, France.
authors.forename: Marie Noëlle
authors.initials: MN
authors.lastname: Delyfer
authors.affiliation: Univ. Bordeaux, ISPED, F-33000 Bordeaux, France; Inserm, U1219 - Bordeaux Population Health Research Center, F-33000 Bordeaux, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Delcourt
authors.affiliation: CHU de Bordeaux, Department of Nutrition-Diabetology, Bordeaux, F-33000, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Blanco
authors.affiliation: CHU de Bordeaux, Department of Nutrition-Diabetology, Bordeaux, F-33000, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Pupier
authors.affiliation: CHU de Bordeaux, Service d'Ophtalmologie, Bordeaux, F-33000, France; Univ. Bordeaux, ISPED, F-33000 Bordeaux, France; Inserm, U1219 - Bordeaux Population Health Research Center, F-33000 Bordeaux, France.
authors.forename: Marie Bénédicte
authors.initials: MB
authors.lastname: Rougier
authors.affiliation: Univ. Bordeaux, ISPED, F-33000 Bordeaux, France; Inserm, U1219 - Bordeaux Population Health Research Center, F-33000 Bordeaux, France.
authors.forename: Kalina
authors.initials: K
authors.lastname: Rajaobelina
authors.affiliation: CHU de Bordeaux, Department of Nutrition-Diabetology, Bordeaux, F-33000, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Hugo
authors.affiliation: CHU de Bordeaux, Service d'Ophtalmologie, Bordeaux, F-33000, France; Univ. Bordeaux, ISPED, F-33000 Bordeaux, France; Inserm, U1219 - Bordeaux Population Health Research Center, F-33000 Bordeaux, France.
authors.forename: Jean François
authors.initials: JF
authors.lastname: Korobelnik
authors.affiliation: CHU de Bordeaux, Department of Nutrition-Diabetology, Bordeaux, F-33000, France; Univ. Bordeaux, ISPED, F-33000 Bordeaux, France; Inserm, U1219 - Bordeaux Population Health Research Center, F-33000 Bordeaux, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Rigalleau
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000150:complications* / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005602:France / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D017127:Glycation End Products, Advanced / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D016015:Logistic Models; D008269:Macular Edema / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging; D015995:Prevalence; D051437:Renal Insufficiency / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors; D012720:Severity of Illness Index; D012867:Skin / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: nephropathy; retinopathy; skin autofluorescence; type 2 diabetes