Skin Autofluorescence, a Marker of Glycaemic Memory in Type 2 Diabetes

Abstract

Glycaemic memory is defined as the deferred consequences of prior hyperglycaemic exposition on the risk of complications. The accumulation of advanced Glycation End products, assessed by the skin autofluorescence (AF), may explain this phenomenon. We evaluated the associations of AF with HbA1c and vascular complications in patients with type 2 diabetes (T2D). We assessed previous HbA1c from the last 120 months (median [IQR] 14 [4, 30]) and the history of vascular complications in T2D patients. The skin AF was measured using an AGE Reader. Association between prior HbA1c and AF tertiles was tested using a mixed regression model with random effects after multiple adjustments. To test the glycaemic memory, analyses were stratified by rising interval time of HbA1c measurements: recent (3 [2, 4]), medium (14 [12, 18]), and old (36 [30, 60] months). The association between AF tertiles and complications was tested by logistic regression model. We collected 2485 HbA1c (mean±SD 8.9±1.9%) measurements in 9patients: 57% men, age 62±10 years, diabetes duration 14±10 years. AF was 2.67±0.66 AU. The highest main [95% CI] HbA1c was observed in the upper AF tertile: T1 8.8 [8.6-9.0], T2 8.9 [8.7-9.1], T3 9.1 [8.9-9.3], p=0.03. This association was greater in patients with the oldest HbA1c measurements: T1 8.4 [8.0-8.9], T2 8.9 [8.4-9.3], T3 9.3 [8.8-9.8], p=0.002. Micro- and macrovascular diseases were observed in 577 and 316 patients, respectively. AF was higher in participants with microvascular (2.79±0.67 vs. 2.46±0.57, p<0.0001) and macrovascular complications (2.78±0.66 vs. 2.61±0.65, p=0.0004) compared to others. Microvascular (T2 vs. T1, OR [95% CI] 1.39 [0.88-2.18], p=0.16; T3 vs. T1 2.20 [1.38-3.57], p=0.001) and macrovascular disease (1.51 [1.02-2.22], p=0.03; 0.99 [0.66-1.49], p=0.96) were associated with the upper AF tertiles in the adjusted model. A high AF was associated with a high HbA1c during the 5 previous years, and related to vascular complications: 2 criteria for being a glycaemic memory marker in T2D patients. Disclosure R. Marine: None. M. Marie: None. K. Mohammedi: Speaker's Bureau; Self; Novo Nordisk Inc.. Other Relationship; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Sanofi. Other Relationship; Self; Sanofi, Takeda Development Centre Europe Ltd., Boehringer Ingelheim Pharmaceuticals, Inc.. L. Blanco: None. V. Rigalleau: None.