# Public Health Screening for Cardiometabolic Risk: Lessons from Advanced Glycation End-Products and ABC Target Achievement in Dalmatian Adults with Type 2 Diabetes

## TL;DR

This study explores how measuring AGEs in skin can help assess heart disease risk in type 2 diabetes patients and finds that few meet key health targets.

## Contribution

The study introduces skin autofluorescence as a novel tool for cardiovascular risk stratification in type 2 diabetes.

## Key findings

- Only 17.5% of participants achieved all three cardiometabolic targets (HbA1c, blood pressure, LDL cholesterol).
- SGLT2 inhibitors were positively associated with target achievement in patients with prior cardiovascular events.
- AGE levels correlated with cardiovascular risk but not with traditional markers like LDL cholesterol.

## Abstract

Background/Objectives: Cardiometabolic risk remains a major challenge in patients with type 2 diabetes mellitus (DMT2). This study aimed to evaluate cardiovascular (CV) risk stratification using advanced glycation end-products (AGEs) measured via skin autofluorescence (SAF) and to assess the achievement of evidence-based ABC targets (HbA1c, blood pressure, low-density lipoprotein (LDL) cholesterol) in adults with DMT2 in Dalmatia. Methods: In this single-center cross-sectional study, 251 adults with DMT2 were stratified by CV risk based on SAF measured AGE levels. Clinical, biochemical, and anthropometric data were collected, including ABC goal attainment and medication use. Statistical analyses compared groups and explored predictors of ABC target achievement using regression models adjusted for clinical factors. Results: Only 17.5% of participants achieved all three ABC goals, indicating suboptimal cardiometabolic control. Those with elevated CV risk had higher hip circumference and lower diastolic blood pressure. Use of sodium-glucose cotransporter 2 (SGLT2) inhibitors was positively associated with ABC goal achievement in patients with prior CV or cerebrovascular events, while higher body mass index was negatively associated. SAF measured AGE levels correlated with cardiometabolic risk but showed no significant differences across LDL cholesterol or other traditional markers. Conclusions: SAF AGE measurement shows potential for CV risk stratification in DMT2 beyond traditional factors. The low rate of ABC goal attainment highlights the need for intensified individualized management incorporating novel biomarkers and therapeutics like SGLT2 inhibitors. Further prospective studies are needed to validate these findings and improve prevention of cardiovascular complications in DMT2.