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Diabetes Metab. 2018 Nov;44(5):424-430. doi: 10.1016/j.diabet.2017.09.002. Epub 2017 Oct 31.

Skin autofluorescence improves the Finnish Diabetes Risk Score in the detection of diabetes in a large population-based cohort: The LifeLines Cohort Study.

Author information

1
Division of Vascular Medicine, Department of Internal Medicine, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, 9713 GZ Groningen, Netherlands. Electronic address: bt.fokkens@umcg.nl.
2
Department of Endocrinology, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, 9713 GZ Groningen, Netherlands.
3
Division of Vascular Medicine, Department of Internal Medicine, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, 9713 GZ Groningen, Netherlands.

Abstract

AIM:

The aim of the present study was to investigate whether skin autofluorescence would improve the Finnish Diabetes Risk Score (FINDRISC) in detecting undiagnosed diabetes in a large population-based cohort.

METHODS:

Included were participants from the Dutch LifeLines Cohort Study. Skin autofluorescence was assessed in an unselected subset of participants using the AGE Reader. After the exclusion of participants with previously diagnosed diabetes (n=1635), pregnant women (n=58) and those using corticosteroids (n=345), 79,248 subjects were eligible for analysis. Diabetes was defined as fasting plasma glucose ≥7.0mmol/L, non-fasting plasma glucose ≥11.1mmol/L or HbA1c ≥6.5% (48mmol/mol).

RESULTS:

Diabetes was detected in 1042 participants (aged 55±12 years; 54% male). Skin autofluorescence improved the area under the receiver operating characteristic (AUROC) curve of the FINDRISC model from 0.802 to 0.811 (P<0.001). Furthermore, the addition of skin autofluorescence to FINDRISC reclassified 8-15% of all participants into more accurate risk categories (NRI: 0.080, 95% CI: 0.052-0.110). The proportion of reclassified participants was especially high (>30%) in the intermediate (1% to <5% and 5% to<10%) risk categories. When skin autofluorescence was added to a simplified model (age+body mass index), its discriminatory performance was similar to the full model+skin autofluorescence (AUROC: 0.806, P=0.062).

CONCLUSION:

Skin autofluorescence is a non-invasive tool that can be used to further improve the FINDRISC for diabetes detection. The new resultant model is especially useful for reclassifying people in the intermediate-risk categories, where additional blood glucose testing is needed to confirm the presence of diabetes.

KEYWORDS:

Advanced glycation endproducts; Diabetes mellitus; Finnish Diabetes Risk Score; Skin autofluorescence

PMID:
29097003
DOI:
10.1016/j.diabet.2017.09.002
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