Skin autofluorescence provides additional information to the UK Prospective Diabetes Study (UKPDS) risk score for the estimation of cardiovascular prognosis in type 2 diabetes mellitus

• Published in: Diabetologia Vol. 52; no. 5; pp. 789 - 797
• Main Authors: Lutgers, H. L, Gerrits, E. G, Graaff, R, Links, T. P, Sluiter, W. J, Gans, R. O, Bilo, H. J, Smit, A. J
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Berlin/Heidelberg : Springer-Verlag 01-05-2009; Springer-Verlag; Springer; Springer Nature B.V
• Subjects: Advanced glycation end-products; Age; Aged; Analysis of Variance; Arm - radiation effects; Biological and medical sciences; Blood Pressure; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Cohort Studies; complications; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - pathology; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - epidemiology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Fluorescence; Glycated Hemoglobin A - metabolism; Glycation End Products, Advanced - metabolism; Human Physiology; Humans; Internal Medicine; Light; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Mortality; Multivariate Analysis; noninsulin-dependent diabetes mellitus; Physicians, Family; Primary care; Prognosis; Risk Assessment; Risk factors; Skin; Skin - radiation effects; UKPDS risk score; United Kingdom; United Kingdom > UK; Netherlands; Type 2 diabetes; UKPDS risk score; Fluorescence; Advanced glycation end-products; Complications; Endocrinopathy; Prognosis; Reaction product; Metabolic diseases; Glycation; Prospective; Risk factor; Complication; Skin
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-009-1308-9

Aims/hypothesis The UK Prospective Diabetes Study (UKPDS) risk engine has become a standard for cardiovascular risk assessment in type 2 diabetes mellitus. Skin autofluorescence was recently introduced as an alternative tool for cardiovascular risk assessment in diabetes. We investigated the prognostic value of skin autofluorescence for cardiovascular events in combination with the UKPDS risk engine in a cohort of patients with type 2 diabetes managed in primary care. Methods Clinical, UKPDS risk engine and skin autofluorescence data were obtained at baseline in 2001-2002 in the type 2 diabetes group (n = 973). Follow-up data concerning fatal and non-fatal cardiovascular events (primary endpoint) were obtained till 2005. Patients were classified as 'low risk' when their 10 year UKPDS risk score for fatal cardiovascular events was <10%, and 'high risk' if >10%. Skin autofluorescence was measured non-invasively with an autofluorescence reader. Skin autofluorescence was classified by the median (i.e. low risk < median, high risk > median). Results The incidence of cardiovascular events was 119 (44 fatal, 75 non-fatal). In multivariate analysis, skin autofluorescence, age, sex and diabetes duration were predictors for the primary endpoint. Addition of skin autofluorescence information to that from the UKPDS risk engine resulted in re-classification of 55 of 203 patients from the low-risk to the high-risk group. The 10 year cardiovascular event rate was higher in patients with a UKPDS score >10% when skin autofluorescence was above the median (55.8% vs 38.9%). Conclusions/interpretation Skin autofluorescence provides additional information to the UKPDS risk engine which can result in risk re-classification of a substantial number of patients. It furthermore identifies patients who have a particularly high risk for developing cardiovascular events.