Skin autofluorescence may independently predict occurrence of first foot ulcer in T2DM patients

A recent study published in the Journal of Diabetes and its Complications found a crucial connection between long-term glycemic memory and the development of vascular complications in individuals with type 2 diabetes, particularly those suffering from Diabetic Foot Ulcers (DFUs). The investigation focused on the role of skin autofluorescence (SAF) of Advanced Glycation End-products (AGEs) as a potential indicator of later DFUs.

The study, which employed a retrospective cohort design, involved the meticulous measurement of SAF using an AGE-Reader among a cohort of 517 patients admitted between 2009 and 2017 due to type 2 diabetes. The patients, 58.0% of whom were male, had an average age of 62±9 years at the start of the study, and an average diabetes duration of 14±10 years.

Notably, the baseline HbA1c levels were recorded at 8.7±1.8%. The cohort's medical history revealed that 33.8% had macroangiopathies, 44.9% had diabetic kidney diseases, and 26.7% had retinopathies. The International Working Group on the Diabetic Foot (IWGDF) classification ranked the DFU risk grades as 0 for 43.2%, 1 for 23.9%, 2 for 7.2%, and 3 for 25.7%.

Over a span of 53 months, 58 new DFUs emerged. Intriguingly, the majority of these cases were observed in patients with SAF measurements exceeding the median value of 2.65 AU. After rigorous adjustment for variables including age, sex, diabetes duration, control measures, arterial hypertension, dyslipidemia, smoking, and other complications, the study demonstrated a robust association between SAF and the subsequent development of DFUs.

Furthermore, even after adjusting for IWGDF classification, SAF remained a strong predictor of new DFUs, with a Hazard Ratio (HR) of 1.81 and a 95% Confidence Interval (CI) of 1.25–2.62.

The study's findings become even more significant when focusing on patients without a prior DFU history. Among this subset of 403 individuals, SAF exhibited an even higher predictive value, with an HR of 2.32 and a 95% CI of 1.36–3.95. Surprisingly, SAF did not demonstrate the same predictive ability for patients who had previously experienced DFUs.

Reference:

Borderie, G., Foussard, N., Larroumet, A., Blanco, L., Barbet-Massin, M.-A., Ducos, C., Rami-Arab, L., Domenge, F., Mohammedi, K., Ducasse, E., Caradu, C., & Rigalleau, V. (2023). The skin autofluorescence of advanced glycation end-products relates to the development of foot ulcers in type 2 diabetes: A longitudinal observational study. In Journal of Diabetes and its Complications (p. 108595). Elsevier BV. https://doi.org/10.1016/j.jdiacomp.2023.108595