Precision Prediction & Precision Medicine


van der Heyden JC, Birnie E, Mul D, Bovenberg S, Veeze HJ, Aanstoot HJ.

Increased skin autofluorescence of children and adolescents with type 1 diabetes despite a well-controlled HbA1c: results from an observational cohort study. BMC Endocr Disord. 2016 Sep 9;16(1):49.

Assessing skin advanced end products (sAGEs) by skin autofluorescence (SAF) has been proposed as a potential surrogate marker for the risk of developing complications of type 1 diabetes. The aim of this study was to investigate if SAF reflects glycemic control expressed by HbA1c in a homogeneous population of children and adolescents with type 1 diabetes.

The researchers performed a cross-sectional analysis in 77 people with type 1 diabetesand 118 healthy controls (age range 11-19 years). The impact of current and past HbA1c values, and other factors, was investigated in a retrospective follow-up cohort study.


Key points:

  • SAF levels were significantly higher in people with type 1 diabetes, compared with controls. This applied across all age categories (11-12, 13-14, 15-16, and 17-18 years old).
  • A univariate analysis showed that age, duration of diabetes, and current and historical HbA1c were associated with SAF. A multivariate analysis, taking into account all factors, showed that historical HbA1c was not associated with SAF.
  • A subgroup of people with type 1 diabetes with HbA1c-within-target (<7.5% or 59 mmol/mol) had high SAF levels, while another subgroup with HbA1c-above target (>7.5% or 59 mmol/mol) showed low SAF levels.



The researchers noted that, consistent with previous studies, people with type 1 diabetesshowed significantly higher SAF than controls, even in the youngest age category. They suggested that for the majority of people with type 1 diabetes SAF “does not seem to provide information additional to HbA1c”.


However, the presumed correlation of high HbA1c with high SAF, and vice versa, did not exist in all people with type 1 diabetes, in whom “use of this non-invasive measure may provide a surrogate marker for diabetic complications, additional to HbA1c”.


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