Cardiovascular disease is frequent in type 2 diabetes mellitus (T2DM), accounting for half of deaths [1]. Conventional risk factors such as dyslipidemia, arterial hypertension and smoking, contribute to cardiovascular events (CVEs) in this population. However, the derived scores insufficiently capture the risk [2], which may-be due to the specific risk from chronic hyperglycemia and microangiopathy.

Advanced glycation end-products (AGEs), generated from hyperglycemia, play an important role in the vascular complications of diabetes [3]. Their serum concentrations do not always relate to the later CVE in T2DM [4]. However, they probably exert their toxic effect in tissues where they are produced and accumulated [5]. Whether they also contribute to the macroangiopathy of T2DM is unknown because there are no skin biopsies studies in this population.

The deposit of AGEs can be indirectly evaluated by measuring their skin autofluorescence (SAF), a finding that has been validated by biopsy study [6]. This pioneering work was extended in the ZODIAC cohort, where SAF predicted later CVEs in high-risk participants with T2DM [7]. Since then, two longitudinal studies analyzed the relationship between SAF and cardiovascular disease [8,9]. These analyses did not adjust for inflammation, nor for the treatment of T2DM, that both play a role in cardiovascular risk.

A few years ago, based on cross-sectional analysis of 905 subjects hospitalized for uncontrolled and/or complicated T2DM, we reported that SAF related to macroangiopathy [10]. Five hundred and four of these subjects were followed during the next five years to analyze the relationship between SAF and later CVE.