Skin autofluorescence predicts incident type 2 diabetes, cardiovascular disease and mortality in the general population

Robert P van Waateringe; Bernardina T Fokkens; Sandra N Slagter; Melanie M van der Klauw; Jana V van Vliet-Ostaptchouk; Reindert Graaff; Andrew D Paterson; Andries J Smit; Helen L Lutgers; Bruce H R Wolffenbuttel

doi:10.1007/s00125-018-4769-x

Skin autofluorescence predicts incident type 2 diabetes, cardiovascular disease and mortality in the general population

Diabetologia. 2019 Feb;62(2):269-280. doi: 10.1007/s00125-018-4769-x. Epub 2018 Nov 21.

Affiliations

¹ Department of Endocrinology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, HPC AA31 9700 RB, Groningen, the Netherlands.
² Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
³ Program in Genetics and Genome Biology, Hospital for Sick Children, Toronto, ON, Canada.
⁴ Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
⁵ Department of Endocrinology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, HPC AA31 9700 RB, Groningen, the Netherlands. bwo@umcg.nl.

Abstract

Aims/hypothesis: Earlier studies have shown that skin autofluorescence measured with an AGE reader estimates the accumulation of AGEs in the skin, which increases with ageing and is associated with the metabolic syndrome and type 2 diabetes. In the present study, we examined whether the measurement of skin autofluorescence can predict 4 year risk of incident type 2 diabetes, cardiovascular disease (CVD) and mortality in the general population.

Methods: For this prospective analysis, we included 72,880 participants of the Dutch Lifelines Cohort Study, who underwent baseline investigations between 2007 and 2013, had validated baseline skin autofluorescence values available and were not known to have diabetes or CVD. Individuals were diagnosed with incident type 2 diabetes by self-report or by a fasting blood glucose ≥7.0 mmol/l or HbA_1c ≥48 mmol/mol (≥6.5%) at follow-up. Participants were diagnosed as having incident CVD (myocardial infarction, coronary interventions, cerebrovascular accident, transient ischaemic attack, intermittent claudication or vascular surgery) by self-report. Mortality was ascertained using the Municipal Personal Records Database.

Results: After a median follow-up of 4 years (range 0.5-10 years), 1056 participants (1.4%) had developed type 2 diabetes, 1258 individuals (1.7%) were diagnosed with CVD, while 928 (1.3%) had died. Baseline skin autofluorescence was elevated in participants with incident type 2 diabetes and/or CVD and in those who had died (all p < 0.001), compared with individuals who survived and remained free of the two diseases. Skin autofluorescence predicted the development of type 2 diabetes, CVD and mortality, independent of several traditional risk factors, such as the metabolic syndrome, glucose and HbA_1c.

Conclusions/interpretation: The non-invasive skin autofluorescence measurement is of clinical value for screening for future risk of type 2 diabetes, CVD and mortality, independent of glycaemic measures and the metabolic syndrome.

Keywords: Ageing; Cardiovascular; Diabetes; Mortality; Prediction; Skin autofluorescence.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Blood Glucose
Cardiovascular Diseases / diagnostic imaging*
Cardiovascular Diseases / epidemiology
Cardiovascular Diseases / mortality
Diabetes Mellitus, Type 2 / diagnostic imaging*
Diabetes Mellitus, Type 2 / epidemiology
Diabetes Mellitus, Type 2 / mortality
Female
Humans
Incidence
Male
Middle Aged
Optical Imaging / methods*
Prospective Studies
Risk Factors
Skin / diagnostic imaging*

Substances

Blood Glucose