In order to reduce the burden of type 2 diabetes mellitus (T2DM) on the health of patients, early risk assessments are required. An effective non-invasive technique to assess a patient’s risk, however, has been lacking. Previous studies have shown that high skin autofluorescence is indicative of cardiovascular complications and mortality related to T2DM, but a comprehensive analysis to establish whether this measurement could be used as a predictive biomarker in the clinic had not been conducted, until now. New research shows that a non-invasive skin autofluorescence measurement can predict T2DM and cardiovascular disease risk.

The autofluorescence measurement is based on the detection of advanced glycation end products (AGEs) in the skin. AGEs are a heterogeneous group of complex molecules that form non-enzymatically in multistep reactions between reducing sugars and proteins, lipids or nucleic acids. AGEs accumulate in skin and the concentration of AGEs in the skin can be assessed easily using an AGE reader, which measures skin autofluorescence.

Credit: Cultura Creative (RF)/Alamy Stock Photo

“I introduced this measurement when screening participants at the beginning of the LifeLines Cohort Study in 2006,” explains Bruce Wolffenbuttel, corresponding author on the study. “This is the first study on the predictive power of skin autofluorescence in the general population with this number of participants (>70,000).”

The authors recorded baseline skin autofluorescence at the start of the study. Four years later they analysed how well this measurement could predict whether patients developed T2DM and/or cardiovascular disease. They found that, compared with participants who lived disease free, baseline skin autofluorescence was increased in patients who developed T2DM or cardiovascular disease, or who died. Notably, skin autofluorescence worked as a predictive tool independent of other risk factors, such as age, sex, waist circumference or smoking status.

We are currently calculating how we can improve the ASCVD and/or Framingham risk score...

Wolffenbuttel hopes that this method will be widely used in the future. “We are currently calculating how we can improve the ASCVD and/or Framingham risk score with this measurement,” concludes Wolffenbuttel. We would also like to investigate how the device can be used as pre-screening before doing oral glucose tolerance tests and other diagnostic work-up for possible T2DM.”