Advanced glycation end products via skin autofluorescence as potential marker of carotid atherosclerosis in patients with type 2 diabetes

Background and aims: Advanced glycation end products (AGEs) are reported to be correlated with diabetic vascular complications. This study aimed to investigate the association between AGEs and carotid atherosclerosis (CAS) as a surrogate marker of cardiovascular disease (CVD). Methods and results: A total of 1006 patients with type 2 diabetes were included. CAS was defined as the presence of carotid arterial atherosclerotic plaque in any of bilateral carotid artery segments measured by ultrasonography. AGEs were measured by the noninvasive skin autofluorescence method. AGE(age) index was calculated as AGEs x age/100. Patients with CAS showed a significantly higher AGE(age) (P < 0.01), and the prevalence of CAS increased with ascending AGE(age) levels (P for trend < 0.001). Logistic regression analysis revealed that AGE(age) was significantly positively associated with odds of CAS, and the odds ratios of the presence of CAS across quartiles of AGE(age) were 1.00, 3.00 [95% confidence interval (CI) 1.90-4.74], 4.04 (95% CI 2.50-6.53 ) and 4.99 (95% CI 2.97-8.40 ) for the multivariable-adjusted model (P for trend <0.001), respectively. In the fully adjusted model, each 5.0 increase in AGE(age) was associated with a 0.019 mm increment in carotid intima-media thickness. Furthermore, AGE(age) presented an acceptable predictive value for CAS, with an optimal cutoff point of 43.2, and the sensitivity, specificity and area under the curve (AUC) were 74.5% (95% CI 70.7-78.1 %), 61.9% (95%CI 57.2-66.4%) and 0.735 (0.706-0.762), respectively. Conclusion: AGE(age), the noninvasive measurement of AGEs combined with age is a promising approach for triaging patients at high risk of CVDs. (C) 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.