1. Precocious “AGE’ing” in Diabetes Precocious “AGE’ing” Effect of Type 1 Diabetes Background T1DM increases formation of advanced glycation end products (AGEs) -AGEs accumulate in tissues over time -Tissue burden is a function of chronologic age AGES are implicated in the development and progression of diabetes complications

2. Precocious “AGE’ing” in Diabetes Objectives To examine the relationship between chronologic age and T1DM on skin AGEs in children Assess accumulated skin AGEs estimated from SIF 405c/420c data in diabetic children versus non-diabetic subjects

3. Precocious “AGE’ing” in Diabetes Study included: Children with T1DM (n=133; mean age 13 years ) Children with T2DM (n=20; mean age 15 years) Healthy children (n=91; mean age 10 years) Healthy adults (n=129; mean age 40 years) Mean duration of T1DM was 6 years and T2DM was 4 years Current and former smokers were excluded Skin AGEs were estimated by measuring skin intrinsic fluorescence (SIF) Patients and Methods

4. Precocious “AGE’ing” in Diabetes Results When adjusted for chronologic age, SIF 420c was higher in children with T1DM and T2DM versus children without diabetes (p<0.05) In subjects without diabetes, SIF 420c increased with chronologic age 43% of children with T1DM and 55% with T2DM had SIF values comparable to adults without diabetes Skin AGEs were associated with HbA 1c but not with mean blood glucose levels

5. Precocious “AGE’ing” in Diabetes SIF 420c

6. Precocious “AGE’ing” in Diabetes Relationship of Chronologic Age with SIF 420c

7. Precocious “AGE’ing” in Diabetes Conclusions Many children with T1DM and T2DM have estimated skin AGE levels comparable to those that would be naturally observed only in adults 20 to 40 years of age Diabetes duration of 4 to 6 years is comparable to about 30 years of chronologic aging Investigators speculated that factors predisposing to precocious accumulation of skin AGEs may predispose patients to precocious development of diabetes complications