Glucose variability measured by continuous glucose monitoring is associated with skin autofluorescence: the Maastricht Study

Abstract

Aims/hypothesis: Glucose variability in people with type 2 diabetes has been associated with increased risk of CVD, and AGEs might be an underlying mechanism. Therefore, this study investigates associations of glucose variability with AGEs in the skin in people with and without impaired fasting glucose, impaired glucose tolerance or diabetes. Methods: We used data from the Maastricht Study, a population-based cohort study. Glucose variability and AGEs in skin were measured by continuous glucose monitoring (CGM) and skin autofluorescence (SAF), respectively. Multiple linear regression was used to test the association of CGM-metrics CV and SD with SAF and adjusted for age, sex, CVD risk factors, nutritional factors and educational level. Interaction analysis was used to test the effect of glucose metabolism status on the association of CV and SD with SAF. Results: We included 795 participants (mean ± SD age 59 ± 8.7 years; 49% were female). Glucose metabolism status was stratified into normal glucose metabolism (n = 459), prediabetes (n = 174) and type 2 diabetes (n = 162). Individuals with type 2 diabetes had higher values of SAF (mean ± SD 2.3 ± 0.6 arbitrary units [AU]) than those with prediabetes (2.1 ± 0.4 AU, p = 0.014) and normal glucose metabolism (2.0 ± 0.4 AU, p = 0.007). In the cohort, both SD (0.152 AU [IQR 0.088–0.217]) and CV (0.014 AU [IQR 0.005–0.017]) were significantly associated with SAF in fully adjusted analyses. Glucose metabolism status did not modify the associations of SD and CV with SAF. Conclusions/interpretation: A higher glucose variability is associated with higher levels of SAF, suggesting that glucose variability plays a role in the formation of AGEs.