High skin autofluorescence, dramatic HbA1c decline increase CV risk in type 2 diabetes
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Hospitalized adults with type 2 diabetes have a higher risk for future cardiovascular events with a dramatic decline in HbA1c coupled with long-term high glucose levels as measured by skin autofluorescence, according to study data.
“Skin autofluorescence may help to define priorities in uncontrolled type 2 diabetes,” Vincent Rigalleau, MD, PhD, head of the diabetology unit, department of endocrinology and nutrition at Bordeaux University Hospital in France, and member of the INSERM research center U897 team, told Healio. “With low skin autofluorescence, focus on glucose control. With high skin autofluorescence, screen for CV complications.”
Rigalleau and colleagues conducted a retrospective cohort study of 386 adults with type 2 diabetes hospitalized at Bordeaux University Hospital from 2009 to 2017 (57.5% men; mean age, 62 years). Patients who had at least one HbA1c measurement the year before hospitalization and who were followed after hospitalization were included. Age, sex, diabetes duration, BMI, arterial hypertension, statin treatment and history of macroangiopathy were recorded. Participants were defined as having a dramatic HbA1c reduction if HbA1c declined 1.5% or more in a span of 4 months. Skin autofluorescence was measured through cutaneous accumulation of advanced glycation end-products on the forearm during hospitalization. New CV events were collected from medical records until December 2020.
The findings were published in the Journal of Diabetes and Its Complications.
Of the study cohort, 16.5% had a dramatic reduction of HbA1c, with a mean reduction from 11% at baseline to 8% at follow-up in those with a dramatic decrease. Adults who did not have a dramatic HbA1c reduction had a relatively stable HbA1c from baseline to follow-up. Most characteristics between those with a dramatic reduction in HbA1c and those without a dramatic reduction were similar.
There were 53 CV events during 51 months of follow-up. HbA1c change did not differ between adults who had a CV event and those who did not. The presence of macroangiopathy at hospitalization was associated with increased risk for new CV events (HR = 3.12; 95% CI, 1.66-5.86), but no increased risk was found in adults with a dramatic decline in HbA1c.
There was no significant difference in skin autofluorescence between patients with a dramatic HbA1c reduction and those with no dramatic reduction. However, there was a significant interaction between skin autofluorescence and dramatic reduction of HbA1c with future CV events (P = .017). After adjusting for age, sex, macroangiopathy history and diabetes treatment, adults with a dramatic decline in HbA1c and a skin autofluorescence of greater than 2.65 arbitrary units had an increased risk for future CV events (HR = 3.84; 95% CI, 1.68-8.76; P = .001).
“Measuring the skin autofluorescence can help to predict the effect of glucose lowering on later CV events,” the researchers wrote. “In patients with high values, glucose control should be slow and cautious, and screening and preventive procedures should be considered.”
Rigalleau said future research should explore whether skin fluorescence and other diabetes-related complications, such as diabetic foot disease, are associated with CV events.
For more information:
Vincent Rigalleau, MD, PhD, can be reached at vincent.rigalleau@chu-bordeaux.fr.
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