Abstract
A large body of evidence demonstrates a relationship between hyperglycemia and increased concentrations of advanced glycation end-products (AGEs). However, there is little information about subcutaneous AGE accumulation in subjects with prediabetes, and whether or not this measurement could assist in the diagnosis of prediabetes is unclear. A cross-sectional study was conducted in 4181 middle-aged subjects without diabetes. Prediabetes (n = 1444) was defined as a glycosylated hemoglobin (HbA1c) level between 39 and 47 mmol/mol (5.7 to 6.4%), and skin autofluorescence (SAF) measurement was performed to assess AGEs. A multivariable logistic regression model and receiver operating characteristic curve were used. The cohort consisted of 50.1% women with an age of 57 [52;62] years, a BMI of 28.3 [25.4;31.6] kg/m2, and a prevalence of prediabetes of 34.5%. Participants with prediabetes showed higher SAF than control participants (2.0 [1.7;2.2] vs. 1.9 [1.7;2.2], p < 0.001). However, HbA1c was not significantly correlated with SAF levels (r = 0.026, p = 0.090). In addition, the SAF level was not independently associated with prediabetes (OR = 1.12 (0.96 to 1.30)). Finally, there was no good cutoff point for SAF to identify patients with prediabetes (AUC = 0.52 (0.50 to 0.54), sensitivity = 0.61, and 1-specificity = 0.56). Given all of this evidence, we can conclude that although there is an increase in SAF levels in participants with prediabetes, the applicability and clinical relevance of the results is low in this population.
Highlights
Advanced glycation end-products (AGEs) constitute a complex group of compounds formed by the slow non-enzymatic glycation of proteins, lipids, and nucleic acids, of which about 20 have been identified to date [1]
Prediabetes, an intermediate metabolic state between type 2 diabetes and normal glucose metabolism, showed a prevalence of 38.6% based on fasting plasma glucose (FPG)/hemoglobin A1c (HbA1c) in the adult population according to the National Health and Nutrition Examination Survey (NHANES) performed between 2017 and 2020 [6]
It is essential to note that prediabetes is not an inconsequential health condition, as it has been associated with an increased incidence of cardiovascular disease and diabetic microangiopathy compared with the population with normal glucose metabolism [7–9]
Summary
Advanced glycation end-products (AGEs) constitute a complex group of compounds formed by the slow non-enzymatic glycation of proteins, lipids, and nucleic acids, of which about 20 have been identified to date [1]. New studies have suggested that the abundance of prooxidant AGEs in the highly industrialized food environment may explain the onset and progression of prediabetes to type 2 diabetes [5]. Prediabetes, an intermediate metabolic state between type 2 diabetes and normal glucose metabolism, showed a prevalence of 38.6% based on fasting plasma glucose (FPG)/hemoglobin A1c (HbA1c) in the adult population according to the National Health and Nutrition Examination Survey (NHANES) performed between 2017 and 2020 [6]. It is essential to note that prediabetes is not an inconsequential health condition, as it has been associated with an increased incidence of cardiovascular disease and diabetic microangiopathy compared with the population with normal glucose metabolism [7–9]. Subcutaneous AGE content, assessed by skin autofluorescence (SAF), has been implicated in the early development of both plaque-burden-associated risk factors and classic microangiopathic complications in diabetes [10–12]
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