Higher skin autofluorescence in young people with Type 1 diabetes and microvascular complications

Aim To test the hypothesis that non‐invasive skin autofluorescence, a measure of advanced glycation end products, would provide a surrogate measure of long‐term glycaemia and be associated with early markers of microvascular complications in adolescents with Type 1 diabetes. Methods Forearm skin autofluorescence (arbitrary units) was measured in a cross‐sectional study of 135 adolescents with Type 1 diabetes [mean ± sd age 15.6 ± 2.1 years, diabetes duration 8.7 ± 3.5 years, HbA 1c 72 ± 16 mmol/mol (8.7 ± 1.5%)]. Retinopathy, assessed using seven‐field stereoscopic fundal photography, was defined as ≥1 microaneurysm or haemorrhage. Cardiac autonomic function was measured by standard deviation of consecutive RR intervals on a 10‐min continuous electrocardiogram recording, as a measure of heart rate variability. Results Skin autofluorescence was significantly associated with age ( R 2 = 0.15; P < 0.001). Age‐ and gender‐adjusted skin autofluorescence was associated with concurrent HbA 1c ( R 2 = 0.32; P < 0.001) and HbA 1c over the previous 2.5–10 years ( R 2 = 0.34–0.43; P < 0.002). Age‐ and gender‐adjusted mean skin autofluorescence was higher in adolescents with retinopathy vs those without retinopathy [mean 1.38 (95% CI 1.29, 1.48) vs 1.22 (95% CI 1.17, 1.26) arbitrary units; P = 0.002]. In multivariable analysis, retinopathy was significantly associated with skin autofluorescence, adjusted for duration ( R 2 = 0.19; P = 0.03). Cardiac autonomic dysfunction was also independently associated with skin autofluorescence ( R 2 = 0.11; P = 0.006). Conclusions Higher skin autofluorescence is associated with retinopathy and cardiac autonomic dysfunction in adolescents with Type 1 diabetes. The relationship between skin autofluorescence and previous glycaemia may provide insight into metabolic memory. Longitudinal studies will determine the utility of skin autofluorescence as a non‐invasive screening tool to predict future microvascular complications.