Skin Autofluorescence Reflects Integration of Past Long-Term Glycemic Control in Patients With Type 1 Diabetes

Abstract

OBJECTIVE The aim was to investigate the relationships between skin autofluorescence (AF) and the impact of past glycemic control and microvascular complications in Japanese patients with type 1 diabetes. RESEARCH DESIGN AND METHODS Two hundred forty-one patients and 110 controls were enrolled. Advanced glycation end product accumulation was measured with AF reader. Three monthly HbA1c levels during the past 20 years were determined from medical records, and the HbA1c area under the curve (AUC) was calculated. We performed multivariate regression analyses to examine the associations between the severity of diabetes complications and various variables. RESULTS Skin AF values increased with increasing the severity of retinopathy (P < 10−11, linear regression analysis) and nephropathy (P < 10−5 for chronic kidney disease stage; P < 10−5 for albuminuria-based stage). HbA1c AUC values over the past 15 years were significantly correlated with skin AF values (past 5 years: R = 0.35, P < 0.0001; past 10 years: R = 0.36, P < 0.0001; past 15 years: R = 0.55, P < 0.0001; past 20 years: R = 0.22, P = 0.13). HbA1c AUC values over the past 3, 5, 10, and 15 years were significantly associated with the severity of both nephropathy and retinopathy. Multivariate analyses in which HbA1c AUC value was removed from the independent variables indicated that only skin AF was independently associated with nephropathy, whereas age at registration, age at onset of diabetes, and skin AF were independently associated with retinopathy. CONCLUSIONS Skin AF reflects past long-term glycemic control and may serve as a surrogate marker for the development of microvascular complications in place of HbA1c AUC value.