Glycoconjugate Journal

, Volume 33, Issue 4, pp 569–579 | Cite as

The pecking order of skin Advanced Glycation Endproducts (AGEs) as long-term markers of glycemic damage and risk factors for micro- and subclinical macrovascular disease progression in Type 1 diabetes

  • Vincent M. Monnier
  • Saul Genuth
  • David R. Sell


To date more than 20 glycation products were identified, of which ~15 in the insoluble human skin collagen fraction. The goal of this review is to streamline 30 years of research and ask a set of important questions: in Type 1 diabetes which glycation products correlate best with 1) past mean glycemia 2) reversibility with improved glycemic control, 2) cross-sectional severity of retinopathy, nephropathy and neuropathy and 3) the future long-term risk of progression of micro- and subclinical macrovascular disease. The trio of glycemia related glycation markers furosine (FUR)/fructose-lysine (FL), glucosepane and methylglyoxal hydroimidazolone (MG-H1) emerges as extraordinarily strong predictors of existing and future microvascular disease progression risk despite adjustment for both past and prospective A1c levels. X2 values are up to 25.1, p values generally less than 0.0001, and significance remains after adjustment for various factors such as A1c, former treatment group, log albumin excretion rate, abnormal autonomic nerve function and LDL levels at baseline. In contrast, subclinical cardiovascular progression is more weakly correlated with AGEs/glycemia with X2 values < 5.0 and p values generally < 0.05 after all adjustments. Except for future carotid intima-media thickness, which correlates with total AGE burden (MG-H1, pentosidine, fluorophore LW-1 and decreased collagen solubility), adjusted FUR and Collagen Fluorescence (CLF) are the strongest markers for future coronary artery calcium deposition, while cardiac hypertrophy is associated with LW-1 and CLF adjusted for A1c. We conclude that a robust clinical skin biopsy AGE risk panel for microvascular disease should include at least FUR/FL, glucosepane and MG-H1, while a macrovascular disease risk panel should include at least FL/FUR, MG-H1, LW-1 and CLF.


Glycation Oxidation Retinopathy Neuropathy Nephropathy Coronary artery calcium Intima media thickness Left ventricular mass Methylglyoxal 



2-amino adipic acid


Advanced glycation endproducts


Hemoglobin A1c






Collagen-linked fluorescence






Carotid intima-medial thickening


Cardiovascular disease


Diabetes Control and Complications Trial


Deoxyglucosone-derived imidazoline crosslink


Epidemiology of Diabetes Interventions and Complications


Glyoxal hydroimidazolone 1


Glyoxal-derived imidazoline crosslink


Glyoxal lysine dimer


Intima media thickness


Liquid chromatography mass spectrometry


Long-wave fluorophore 1


Myocardial infarct


Methylglyoxal hydroimidazolone


Methylglyoxal-derived imidazoline crosslink


Methylglyoxal lysine dimer


Pulse wave velocity


Skin autofluorescence


Skin intrinsic fluorescence


Standard deviation



This work was supported by grants from NIDDK (R21 DK-79432 to DRS, DK-101123 to VMM), JDRF (17-2010-318) and NEI (EY-07099 to VMM) and NIH and non-governmental grants to The DCCT/EDIC Research Group. We thank our colleagues from the DCCT/EDIC trial and the team of biostatisticians at the DCCT coordinating Center, Drs. Wanjie Sun, Xiaoyu Gao, Patricia A. Cleary and John M. Lachin for their help throughout the years.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Vincent M. Monnier
    • 1
    • 2
  • Saul Genuth
    • 3
  • David R. Sell
    • 1
  1. 1.Department of PathologyCase Western Reserve UniversityClevelandUSA
  2. 2.Department of BiochemistryCase Western Reserve UniversityClevelandUSA
  3. 3.Department of MedicineCase Western Reserve UniversityClevelandUSA

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