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Barbara E K Klein, Kayla Horak, John D Maynard, Kristine E Lee, Ronald Klein; Skin Intrinsic Fluorescence and Complications of Type 1 Diabetes: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1594.
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© 2017 Association for Research in Vision and Ophthalmology.
To determine whether there is an association between skin intrinsic fluorescence, a marker of accumulated advanced glycation endproducts and oxidative stress in the skin, and complications of type 1 diabetes of long duration.
252 of 441 participants in the Wisconsin Epidemiologic Study of Diabetic Retinopathy at a 32-year follow-up examination had complete data on physical examination, fundus photography, and skin intrinsic fluorescence. Skin intrinsic fluorescence was measured with the SCOUT skin fluorescence spectrometer, which used light emitting diodes (LEDs) centered at 375 nm (SIF01) and 459 nm (SIF15) to excite skin fluorescence and measured the resulting emission over the 435-655 nm and 490-655 nm spectral regions, respectively. In addition, a white LED was used to measure skin reflectance over the 435-655 nm region, allowing intrinsic correction of individual subjects’ measured fluorescence for variation in skin tone. Fundus photographs were graded according to the modified Early Treatment of Diabetic Retinopathy Study (ETDRS) protocol. Presence of diabetic kidney disease was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m2 according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula or proteinuria of ≥3 g/l. Sensory peripheral neuropathy was assessed by history.
In multivariable models that adjusted for age (per 5 years) and glycosylated hemoglobin A1c, both SIF01 and SIF15 were associated with diabetic neuropathy (SIF01: Odds Ratio [OR]=1.33 [95% Confidence Interval [CI] 1.14-1.56]; SIF15: OR=1.30 [95% CI 1.14-1.48]). In models that additionally adjusted for diabetes duration, triglycerides and systolic blood pressure, SIF01 and SIF15 were also associated with proliferative diabetic retinopathy (SIF01: OR=1.25 [95% CI 1.07-1.45]; SIF15: OR=1.22 [95% CI 1.07-1.38]) and with diabetic renal disease (SIF01: OR=1.54 [95% CI 1.28-1.87]; SIF15: OR=1.27 [95% CI 1.10-1.46]).
Skin intrinsic fluorescence measures are independently associated with microvascular complications of type 1 diabetes (proliferative retinopathy, renal disease, neuropathy) in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. However, incidence information is needed to determine whether there is a likely causal relationship.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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