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

• Published in: Diabetologia Vol. 62; no. 2; pp. 269 - 280
• Main Authors: van Waateringe, Robert P., Fokkens, Bernardina T., Slagter, Sandra N., van der Klauw, Melanie M., van Vliet-Ostaptchouk, Jana V., Graaff, Reindert, Paterson, Andrew D., Smit, Andries J., Lutgers, Helen L., Wolffenbuttel, Bruce H. R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2019; Springer Nature B.V
• Subjects: Adult; Aged; Aging; Blood Glucose; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - diagnostic imaging; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - diagnostic imaging; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - mortality; Female; Human Physiology; Humans; Incidence; Internal Medicine; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Metabolic syndrome; Middle Aged; Mortality; Myocardial infarction; Optical Imaging - methods; Population studies; Prospective Studies; Risk Factors; Skin - diagnostic imaging; Skin diseases; Stroke; Surgery; Transient ischemic attack; Skin autofluorescence; Diabetes; Cardiovascular; Ageing; Mortality; Prediction
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-018-4769-x

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.