Skin intrinsic fluorescence scores are a predictor of all-cause mortality risk in type 1 diabetes: The Epidemiology of Diabetes Complications study

• Published in: Journal of diabetes and its complications 2021-02, Vol.35 (2), p.107770-107770, Article 107770
• Main Authors: Tomaszewski, Erin L., Orchard, Trevor J., Hawkins, Marquis, Conway, Baqiyyah N., Buchanich, Jeanine M., Maynard, John, Songer, Thomas, Costacou, Tina
• Format: Article
• Language: English
• Subjects: Adult; Age; All-cause mortality; Blood; Cholesterol; Chromatography; Collagen; Creatinine; Devices; Diabetes; Diabetes Complications; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - epidemiology; Epidemiology; Female; Fluorescence; Glycation End Products, Advanced - analysis; Glycation/AGE; Hemoglobin; Humans; Insulin resistance; Life expectancy; Light emitting diodes; Male; Middle Aged; Mortality; Retrospective Studies; Risk Factors; Skin; Skin - diagnostic imaging; Skin intrinsic fluorescence; Type 1 diabetes
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2020.107770

We assessed the association of skin intrinsic fluorescence (SIF) scores, as a measure of advanced glycation end-products (AGE), with all-cause mortality in type 1 diabetes (T1D). This is an observational retrospective study of a convenience sample from the Epidemiology of Diabetes Complications (EDC) study. AGEs were measured with a SIF score between 2007 and 2014; vital status was assessed in 2020. Among 245 participants, mean age was 48.6 ± 7.4 years, median diabetes duration was 39.5 years (IQR: 34.2, 44.9), and 53.5% were female. Compared to survivors, the deceased (n = 20) were older, with higher SIF scores, longer diabetes duration, lower body mass index (BMI), and an adverse risk factor profile (all p≤0.05). Univariate Cox regression showed a marginal association between SIF score and mortality (HR: 1.1, 95% CI 0.9–1.2, p = 0.06), which persisted after adjustment for multiple daily insulin shots/pump (MDI) use (HR: 1.1, 95% CI 1.0–1.2, p = 0.04). This association was attenuated after adjustment for T1D duration, A1c months, or estimated glomerular filtration rate (eGFR). In individuals with long duration T1D, SIF scores adjusted for MDI predicted all-cause mortality, although this association was attenuated after adjustments. Given the nature of sampling and small number of events, our findings require replication. •AGE accumulation is particularly harmful for patients with T1D and have been associated with mortality in T1D.•We sought to identify the relationship between collagen-linked AGE, assessed via SIF scores, and all-cause mortality in T1D.•We found a marginal association between skin intrinsic fluorescence score and mortality which persisted after adjustment for multiple daily insulin shots/pump use.•This association was attenuated after adjustment for T1D duration, A1c months, or estimated glomerular filtration rate.•Our work also demonstrates that non-invasive SIF scores provide a novel approach for monitoring the role of AGEs in T1D.