Background. The patients’ quality of life (QoL) has emerged in the last decades as measurable characteristic and also as a therapeutic target. The Norfolk QoL in diabetic neuropathy (QoL-DN) is a well validated 35 items QoL questionnaire, with a good sensitivity and specificity in identifying patients with diabetic neuropathy (DN). The measurement of skin autofluorescence (SAF) has also emerged as relatively simple method for quantifying the long term glycemic exposure in patients with diabetes, showing a good correlation with the risk/presence for/of chronic complications, including DN.
Aim and methods.  This is a sub-analisys of a cross-sectional, analytic, multicenter study in which consecutive outpatients with type 1 diabetes mellitus (T1DM) or T2DM who attended diabetic units for regular diabetes care were included. The patients were on a stable regimen of antidiabetic, antihypertensive and lipid lowering treatment for the last 3 months, 30 to 75 years of age, BMI between 25 and 45 kg/m2 and HbA1c </= 9.5 %. The aim of this sub-analisys was to explore correlations between SAF, the presence of DN and the QoL-DN scores. SAF was assessed using the AGE Reader (Groningen, The Netherlands), measurements were performed at the forearm, and results of 3 measurements were averaged. For DNP evaluation the Toronto Clinical Neuropathy Score (TCNS), the Neuropathy Symptoms Score (NSS) and the Neuropathy Disability Score (NDS) were used. The Romanian version of Norfolk QoL-DN was self-administrated by the patients and analyzed as total score and sub-domains (physical functioning/ large-fibre neuropathy, activities of daily living, symptoms, autonomic neuropathy and small fibre neuropathy) scores. We have done descriptive statistics and we used the Sperman’s correlation coefficient.
Results. There were 497 patients included in the study, 51.3% females, 93.4% with type 2 diabetes, with a mean (±SD) age of 60.54 (9.10) years and a mean(±SD) duration  of diabetes of 17.36 (9.96)  and 9.20(5.53) years for with T1DM and T2DM respectively. The median (25th-75th percentile) SAF score (arbitrary units) was higher in those with poorer QoL (total score>5), 2.37 (2.13-2.77) vs. 2.53 (2.17-2.87) but without reaching statistical significance (p=0.178). The same trend, without statistical significance,   was observed for all the five sub-domains of QoL-DN. Those who responded “yes” to the question “Have you ever been told that you have neuropathy?” had a significantly higher median (25th-75th percentile) SA score 2.4 (2.13-2.73) vs. 2.6 (2.17-2.9), p=0.008.   A small non statistical significant positive correlation existed between total QoL-DN score and SA score in the entire group, r=0.06, p=0.181. There was a surprisingly marginal negative correlation, r = -0.06, p=0.338, between SA score and total QoL-DN score in the patients with DN (TCNS score>5). 
Conclusions.  Our study showed a tendency to concordance between higher scores of SF and poorer quality of life in patients with diabetes. The association between two so different aspects of the DN, the implication of long term glycation process and the quality of life in these patients, should be further explored.

Can be skin autofluorescence an indicator for the quality of life in patients with diabetic neuropathy?