Association of advanced glycation end products with diabetic retinopathy in type 2 diabetes mellitus

Lingwen Ying; Yun Shen; Yang Zhang; Yikun Wang; Yong Liu; Jun Yin; Yufei Wang; Jingrong Yin; Wei Zhu; Yuqian Bao; Jian Zhou

doi:10.1016/j.diabres.2021.108880

Association of advanced glycation end products with diabetic retinopathy in type 2 diabetes mellitus

Diabetes Res Clin Pract. 2021 Jul:177:108880. doi: 10.1016/j.diabres.2021.108880. Epub 2021 May 29.

Authors

Lingwen Ying¹, Yun Shen¹, Yang Zhang², Yikun Wang³, Yong Liu⁴, Jun Yin¹, Yufei Wang¹, Jingrong Yin¹, Wei Zhu¹, Yuqian Bao¹, Jian Zhou⁵

Affiliations

¹ Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai 200233, China.
² Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei 230031, China; University of Science and Technology of China, Hefei 230026, China.
³ Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei 230031, China. Electronic address: wyk@aiofm.ac.cn.
⁴ Anhui Institute of Optics and Fine Mechanics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei 230031, China.
⁵ Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai 200233, China. Electronic address: zhoujian@sjtu.edu.cn.

PMID: 34058298
DOI: 10.1016/j.diabres.2021.108880

Abstract

Aims: Advanced glycation end products (AGEs) were reported to be associated with diabetes development and diabetes related complications when accumulated in high levels. This study investigated the association between AGEs and diabetic retinopathy (DR).

Methods: A total of 1,471 patients with type 2 diabetes were enrolled. Fundus radiography was used for DR measurement. AGEs were detected through non-invasive skin autofluorescence method.

Results: Patients with more advanced DR showed a much higher AGEs, and the prevalence of DR (based on the severity) increase with ascending AGEs quartiles (all P for trend < 0.001). The multivariable-adjusted odds ratios of any DR across AGEs quartiles were 1.00, 1.69 (95% confidence interval [CI] 1.16-2.47), 1.58 (95%CI 1.06-2.37) and 1.60 (95%CI 1.05-2.44) (P for trend = 0.044), respectively. Similar results were found in vision-threatening DR (VTDR) subgroup (P for trend = 0.009). When AGEs was considered as a continuous variable by using restricted cubic splines, a graded positive association of AGEs with the odds of any presence of DR was observed (P for trend < 0.001). Further, we found that AGEs presented the similar predictive value for any DR with glycated hemoglobin A_1c (HbA_1c). When it comes to VTDR, AGEs showed a significantly higher efficacy in early screening than HbA_1c (P = 0.002). With a cut-off point of 77.1, the sensitivity, specificity and area under the curve of AGEs were 90.0% (95%CI 76.3-97.2%), 49.4% (95%CI 46.8-52.0%), and 0.728 (95%CI 0.704-0.750), respectively.

Conclusion: Non-invasive measured skin AGEs, associated with the prevalence of all stages of DR, might be a more suitable indicator than HbA_1c for mimicking the poor prognosis of hyperglycemia.

Keywords: Advanced glycation end products; Diabetic retinopathy; Non-invasive; Type 2 diabetes.

MeSH terms

Cross-Sectional Studies
Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / epidemiology
Diabetic Retinopathy* / diagnosis
Diabetic Retinopathy* / epidemiology
Diabetic Retinopathy* / etiology
Glycated Hemoglobin / analysis
Glycation End Products, Advanced
Humans

Substances

Glycated Hemoglobin A
Glycation End Products, Advanced