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

Fernando, Malindu E., Crowther, Robert G., Lazzarini, Peter A., Sangla, Kunwarjit S., Wearing, Scott, Buttner, Petra, and Golledge, Jonathan (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.

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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.

Item ID: 61742
Item Type: Article (Research - C1)
ISSN: 1932-2968
Keywords: advanced glycation end products, diabetes mellitus, diabetic foot, measurement variability, skin autofluorescence, tissue glycation
Copyright Information: © 2019 Diabetes Technology Society.
Funders: Queensland Government Department of Health (QG-DH), James Cook University (JCU), National Health and Medical Research Council (NHMRC)
Projects and Grants: QG-DH Health Practitioner Research Grant Scheme (2013-2014), JCU Graduate Research School, JCU The Ulcer and Wound Healing Consortium (UHEAL) SRIF, NHMRC Grant No. 1117061
Date Deposited: 26 Feb 2020 00:54
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320199 Cardiovascular medicine and haematology not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified @ 100%
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