Elsevier

Diabetes & Metabolism

Volume 44, Issue 5, November 2018, Pages 424-430
Diabetes & Metabolism

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

https://doi.org/10.1016/j.diabet.2017.09.002Get rights and content
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open access

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 ≥ 7.0 mmol/L, non-fasting plasma glucose ≥ 11.1 mmol/L or HbA1c ≥ 6.5% (48 mmol/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

Abbreviations

AGE
advanced glycation endproduct
AUC
area under the curve
AUROC
area under the receiver operating characteristic curve
FINDRISC
Finnish Diabetes Risk Score
NRI
net reclassification improvement
OGTT
oral glucose tolerance test
SAF
skin autofluorescence

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