Abstract
Context: China has the largest number of people with type 2 diabetes mellitus (T2DM) in the world. Data from previous studies suggested that up to one-fifth of individuals with diabetes would be missed without an oral glucose tolerance test (OGTT). To date there is little information on the mortality risk of these individuals.
Objective: We estimated the association of different indicators of hyperglycaemia with mortality in the general Chinese population.
Design: Prospective cohort study
Setting: China
Participants: 17,939 participants aged 50+ years
Exposures: Previously diagnosed diabetes and newly detected diabetes defined by fasting glucose (≥7.0 mmol/L), 2h post-load glucose (≥11.1 mmol/L), or haemoglobin A1c (HbA1c, ≥6.5%).
Main Outcomes Measures: Deaths from all-cause, cardiovascular disease and cancer were identified by record linkage with death registration.
Results: During 7.8 (standard deviation=1.5) years’ follow-up, 1,439 deaths were recorded. Of 3,706 participants with T2DM, 2126 (57%) had known T2DM, 118 (3%) were identified by isolated elevated fasting glucose, 1022 (28%) had isolated elevated post-load glucose, and 440 (12%) had both elevated fasting and post-load glucose. Compared to normoglycaemia, the HR (95% CI) of all-cause mortality was 1.71 (1.46, 2.00), 0.96 (0.47, 1.93), 1.43 (1.15-1.78) and 1.82 (1.35-2.45) for the four groups above, respectively. T2DM defined by elevated HbA1c was not significantly associated with all-cause mortality (HR 1.17, 95% 0.81-1.69).
Conclusion: Individuals with isolated higher 2h post-load glucose had a higher risk of mortality by 43% than those with normoglycaemia. Under-use of OGTT leads to substantial under-detection of individuals with a higher mortality risk and lost opportunities for early intervention.
Objective: We estimated the association of different indicators of hyperglycaemia with mortality in the general Chinese population.
Design: Prospective cohort study
Setting: China
Participants: 17,939 participants aged 50+ years
Exposures: Previously diagnosed diabetes and newly detected diabetes defined by fasting glucose (≥7.0 mmol/L), 2h post-load glucose (≥11.1 mmol/L), or haemoglobin A1c (HbA1c, ≥6.5%).
Main Outcomes Measures: Deaths from all-cause, cardiovascular disease and cancer were identified by record linkage with death registration.
Results: During 7.8 (standard deviation=1.5) years’ follow-up, 1,439 deaths were recorded. Of 3,706 participants with T2DM, 2126 (57%) had known T2DM, 118 (3%) were identified by isolated elevated fasting glucose, 1022 (28%) had isolated elevated post-load glucose, and 440 (12%) had both elevated fasting and post-load glucose. Compared to normoglycaemia, the HR (95% CI) of all-cause mortality was 1.71 (1.46, 2.00), 0.96 (0.47, 1.93), 1.43 (1.15-1.78) and 1.82 (1.35-2.45) for the four groups above, respectively. T2DM defined by elevated HbA1c was not significantly associated with all-cause mortality (HR 1.17, 95% 0.81-1.69).
Conclusion: Individuals with isolated higher 2h post-load glucose had a higher risk of mortality by 43% than those with normoglycaemia. Under-use of OGTT leads to substantial under-detection of individuals with a higher mortality risk and lost opportunities for early intervention.
| Original language | English |
|---|---|
| Journal | Journal of Clinical Endocrinology and Metabolism |
| Early online date | 2 Nov 2019 |
| DOIs | |
| Publication status | E-pub ahead of print - 2 Nov 2019 |
Access to Document
- Jiang_et_al_Glycaemic_measures_and_risk_Journal_of_Clinical_Endocrinology_and_Metabolism_2019
This is a pre-copyedited, author-produced version of an article accepted for publication in Journal of Clinical Endocrinology and Metabolism following peer review. The version of record Chao Qiang Jiang, Lin Xu, Tai Hing Lam, Ya Li Jin, Wei Sen Zhang, Feng Zhu, G Neil Thomas, Kar Keung Cheng, Glycaemic measures and risk of mortality in older Chinese: the Guangzhou Biobank Cohort Study, The Journal of Clinical Endocrinology & Metabolism, dgz173 is available online at: https://doi.org/10.1210/clinem/dgz173