Autofluorescence cutanée prédictive de macroangiopathie dans le diabète de type 1 après 7 ans de suivi d'une cohorte de 243 patients

Abstract : Advanced Glycation end-products play a role in diabetic vascular complications. Their optical properties allow to non invasively evaluate their accumulation in tissue by measuring skin autofluorescence (SAF). SAF predicts macrovascular complications in type 2 diabetes mellitus but it was not demonstrated in type 1 diabetes. The aim of our study was to search for an association between SAF and macrovascular event (MVE) incidence: myocardial infarction, stroke, gangrene or artery revascularization procedures during a 7 years follow-up. In 2009, 246 subjects with type 1 diabetes patients were included. SAF measurement, clinical (age, sex, BMI, comorbidities) and biological data (glycemia, HbA1C, renal parameters, blood lipids) were recorded. MVE were registered at visit in the center or phone call to medical practitioner until 2016. They were mainly men 58.8% (n=143), mean age 51.2 years (±16.7) with BMI 24.9 kg/m2 (± 4.1), diabetes duration 21.4 years (±13.8), HbA1C 7.6% (± 1.1). Among these DT1 patients, 25.7% (n=59) were smokers, 44.9% (n=109) had arterial hypertension, LDL cholesterol was 1.04 (± 0.29) g/L. Estimated Glomerular Filtration Rates (CKD-EPI) was 86.3 ml/min/1.73m2 (±26.6) and albumin excretion rates was 54.9mg/24H (± 220.0). Twenty-four subjects had a history of previous MVE (9.9%). From 2009 to 2016, 18 patients had new MVE : 4 myocardial infarctions, 2 gangrene, 17 artery revascularizations. Their SAF was 2.46 (±0.71) UA vs 2.10 (±0.55) for others patients (p=0.02). After adjustment for cardiovascular risk factors (age, sex, diabetes duration, BMI, hypertension, smoking status, blood lipids, albumin excretion rates, statins treatment and MVE previous to 2009), the association between high level SAF in 2009 and MVE incidence during seven years was still significant HR 4.13[1.30-13.07],p=0,02. A high SAF is predictive of MVE incidence in patients with type1 diabetes.
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Master Thesis
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Christèle Blanc-Bisson. Autofluorescence cutanée prédictive de macroangiopathie dans le diabète de type 1 après 7 ans de suivi d'une cohorte de 243 patients. Médecine humaine et pathologie. 2018. ⟨dumas-01970425⟩

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