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Skin Intrinsic Fluorescence in the Epidemiology of Diabetes and Complications Study: Predictors and Association with all-cause Mortality

Tomaszewski, Erin (2021) Skin Intrinsic Fluorescence in the Epidemiology of Diabetes and Complications Study: Predictors and Association with all-cause Mortality. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Aims: The published literature suggests that higher skin intrinsic fluorescence (SIF), as a marker of advanced glycation endproducts (AGE), is associated with worse health status in type 1 diabetes (T1D). The first two aims of this dissertation test the relationship between traditional vascular disease risk factors as well as T1D-related complications, and SIF change among individuals with long-term T1D. The third aim assesses the association between SIF and all-cause mortality in T1D.
Methods: Data were from the 30-year longitudinal Epidemiology of Diabetes and Complications (EDC) study of individuals diagnosed with childhood-onset T1D at the Children’s Hospital of Pittsburgh, PA, USA, between 1950-80. EDC participants were followed for 30 years biennially providing medical history, lifestyle, demographic, and diabetes self-care survey information. SIF was collected from a convenience sample of EDC participants (n=245) between 2007-14. Mortality status was evaluated as of May 2020. Regression models were run to evaluate predictors of SIF scores; Cox regression was used evaluate SIF and all-cause mortality.
Results: We observed that modifiable T1D-related complication risk factors and markers at analytic baseline, such as worse blood glucose control and lower kidney function, were associated with increased SIF scores over a mean of 5.2 years follow up. Further, increased albuminuria at analytic baseline was associated with decreased SIF scores during follow-up. Body mass index change was marginally and inversely associated with SIF score change. SIF was univariately associated with all-cause mortality; this association remained significant after adjustment for multiple daily insulin shots/pump use, but not after adjustment for diabetes duration, A1c months, or estimated glomerular filtration rate.
Conclusion: The predictors of SIF change identified are aligned with known biological processes that occur during AGE formation, accumulation, and deposition on long lived proteins. Regarding all-cause mortality, this work builds on existing evidence that AGEs may play a role in ageing. Taken together, this work supports the existing evidence that AGEs may be a marker of complication status in T1D, and that AGEs may predict risk of accelerated ageing. Further work is needed to establish the meaningfulness of SIF scores.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Tomaszewski, Erinert31@pitt.edu0000-0003-3995-3127
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairSonger,
Committee CoChairCostacou,
Committee MemberOrchard,
Committee MemberHawkins,
Committee MemberBuchanich,
Committee MemberMaynard,
Date: 19 January 2021
Date Type: Publication
Defense Date: 14 October 2020
Approval Date: 19 January 2021
Submission Date: 10 December 2020
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 161
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: type 1 diabetes, skin intrinsic fluorescence, advanced glycation endproduct
Date Deposited: 19 Jan 2021 20:02
Last Modified: 19 Jan 2023 06:15


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