Within- and between-body-site agreement of skin autofluorescence measurements in people with and without diabetes-related foot disease

Journal article


Fernando, Malindu E., Crowther, Robert, Lazzarini, Peter, Sangla, Kunwarjit, Wearing, Scott C., Buettner, Petra and Golledge, Jonathon. (2019). Within- and between-body-site agreement of skin autofluorescence measurements in people with and without diabetes-related foot disease. Journal of Diabetes Science and Technology. 13(5), pp. 836-846. https://doi.org/10.1177/1932296819853555
AuthorsFernando, Malindu E., Crowther, Robert, Lazzarini, Peter, Sangla, Kunwarjit, Wearing, Scott C., Buettner, Petra and Golledge, Jonathon
Abstract

Background:
Skin autofluorescence has been used to assess longer term glycemic control and risk of complications. There is however no agreed site at which autofluorescence should be measured. This study evaluated the within- and between-site agreement in measurement of skin autofluorescence using a noninvasive advanced glycation end product (AGE) reader.

Methods:
Overall, 132 participants were included: 16 with diabetes-related foot ulcers (DFU), 63 with diabetes but without foot ulcers (DMC), 53 without diabetes or foot ulcers (HC). Skin autofluorescence was measured using the AGE Reader (DiagnOptics technologies BV, the Netherlands). Three consecutive skin autofluorescence measurements were each performed at six different body sites: the volar surfaces of both forearms (arms), dorsal surfaces of both calves (legs), and plantar surfaces of both feet (feet). Within- and between-site agreements were analyzed with concordance correlation coefficients (CCC) and 95% confidence intervals (95% CI), absolute mean differences (±standard deviation), and Bland-Altman limits of agreement.

Results:
The agreement between repeat assessments at the same site was almost perfect (CCC [95% CI] ranging from 0.94 [0.91-0.96] for assessments in the right foot to 0.99 [0.99-0.99] for assessments in the left arm). The limits of agreement were narrow within ±0.5 arbitrary units for all sites. The between-site agreement in measurements was poor (CCC < 0.65) with large maximum absolute mean differences (±SD) in arbitrary units (DFU = 3.40 [±2.04]; DMC = 3.15 [±2.45]; HC = 2.72 [±1.83]) and wide limits of agreement.

Conclusions:
Skin autofluorescence measurements can be repeated at the same site with adequate repeatability but measurements at different sites in the same patient have marked differences. The reason for this variation across sites and whether this has any role in diabetes-related complications needs further investigation.

Keywordsadvanced glycation end products; diabetes mellitus; diabetic foot; measurement variability; tissue glycation; skin autofluorescence
Year2019
JournalJournal of Diabetes Science and Technology
Journal citation13 (5), pp. 836-846
PublisherSAGE Publications
ISSN1932-2968
Digital Object Identifier (DOI)https://doi.org/10.1177/1932296819853555
PubMed ID31204497
Scopus EID2-s2.0-85067877014
PubMed Central IDPMC6955457
Page range836-846
FunderDepartment of Health, Queensland Government
James Cook University
National Health and Medical Research Council (NHMRC)
Queensland Government
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online16 Jun 2019
Publication process dates
Deposited29 Nov 2023
Grant ID1117061
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