Skin autofluorescence predicts cardio-renal outcome in type 1 diabetes: a longitudinal study

Abstract

BackgroundWe aimed to analyze the relationships between skin autofluorescence (SAF) and incident macrovascular events and renal impairment after 4 years of follow-up in patients with type 1 diabetes (T1D).MethodsTwo hundred and forty-three patients (51.2 ± 16.7 years old) with T1D participated. SAF was measured by AGE-Reader-TM at inclusion. Macrovascular events (MVE), estimated glomerular filtration rate (eGFR) and urinary albumin excretion rate (AER) were recorded then and 4 years later. Multivariate logistic regression was used to analyze the relationships between SAF and incident MVE and renal profile 4 years later.ResultsPatients with incident MVE had a higher SAF (p = 0.003). SAF predicted incident MVE after adjustment for age, sex, body mass index, tobacco, diabetes duration, hypertension, HbA1c, AER, eGFR (OR 4.84 [95 % CI 1.31–17.89], p = 0.018). However, this relation was no longer significant after adjustment for history of MVE. An inverse relation was found between SAF and incident eGFR (p = 0.0001). Patients with incident eGFR <60 ml/min/1.73 m2 had a SAF higher than patients with normal eGFR. After adjustment for the previous criteria, SAF remained associated with the risk of impaired incident eGFR (OR 7.42 [95 % CI 1.59–34.65], p = 0.018). No relation was found between SAF and increased AER 4 years later.ConclusionsSAF predicts MVE in patients with T1D, adjusted for cardiovascular risk factors but the most powerful predictive factor remains history of MVE. SAF also predicts eGFR impairment, adjusted for initial AER and renal function. SAF could be a useful non-invasive tool for estimating risk of cardiovascular or renal impairment in patients with T1D.

Predictors of early renal function decline in Type 1 diabetes: retinopathy

“…The normal skin autofluorescence in our participants who later experienced fast renal function decline was not the result we expected, as we have recently shown that skin autofluorescence predicted later eGFR impairment (<60 ml/ min/1.73 m 2 ) in Type 1 diabetes [5]; however, we have also shown that the most powerful predictor (odds ratio 48, 95% CI 8.8-261) of this later eGFR impairment was a low initial eGFR, which was not present in the participants with fast renal function decline in our study: their initial eGFR ª 2017 Diabetes UK was higher, at 96 ml/min/1.73 m 2 (vs 85 AE 23 for those without fast renal function decline; P < 0.05), in accordance with previous reports, including the study by Bjornstad et al [1,2]. These initially high eGFRs probably explain why skin autofluorescence was even a little lower in those with later fast renal function decline; skin autofluorescence is strongly related to concomitant eGFR in people with Type 1 diabetes [5]. This relationship was also observed for skin intrinsic fluorescence in the participants with eGFR >60 ml/ min/1.73 m 2 in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) [9].…”

“…An indirect indication may be obtained from the retinal status of people who experience this fast decline, but this has not yet been documented, to our knowledge. Advanced glycation end-products can promote inflammation, endothelial dysfunction and microangiopathy [4], and we have recently reported that their accumulation, evaluated through skin autofluorescence, predicted later impairment of eGFR (<60 ml/min/1.73 m 2 ) in people with Type 1 diabetes [5]. The role of advanced glycation end-products in fast decline of eGFR, however, is also unknown.…”

“…In people with Type 1 diabetes assessed in our department, eGFRs [calculated using the Chronic Kidney Disease Epidemiology collaboration (CKD-EPI) formula] were determined in both 2009 and 2013 [5]. Of the 207 participants, 42% were women, and their mean AE sd age was 52 AE 15 years, diabetes duration 22 AE 14 years and HbA 1c level 59 AE 10 mmol/mol (7.5 AE 0.9%).…”

Progression of skin autofluorescence of AGEs over 4 years in patients with type 1 diabetes

“…In 240 patients with type 1 diabetes, we measured sAF during year 2009 . We have recently reported that these sAF were associated to diabetic peripheral neuropathy and that they predicted later estimated glomerular filtration rates and cardiovascular events . One hundred and fifty‐four patients had a second sAF measurement 4 years later.…”

“…8 We have recently reported that these sAF were associated to diabetic peripheral neuropathy 10 and that they predicted later estimated glomerular filtration rates and cardiovascular events. 11 One hundred and fifty-four patients had a second sAF measurement 4 years later. We analysed the relationship between the progression of sAF and their modality of treatment (continuous subcutaneous insulin infusion [CSII] vs multiple daily injections) and renal outcomes.…”