Affiliation:
1. Guangzhou No.12 Hospital, Guangzhou, China
2. School of Public Health, Sun Yat-sen University, Guangzhou, China
3. School of Public Health, the University of Hong Kong, Hong Kong
4. Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Abstract
Abstract
Context
China has the largest number of people with type 2 diabetes mellitus (T2DM) in the world. Data from previous studies have 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 hyperglycemia with mortality in the general Chinese population.
Design
Prospective cohort study.
Setting
China.
Participants
A total of 17 939 participants aged 50+ years.
Exposures
Previously diagnosed diabetes and newly detected diabetes defined by fasting glucose (≥7.0 mmol/L), 2-hour postload glucose (≥11.1 mmol/L), or hemoglobin 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 (SD, 1.5) years’ follow-up, 1439 deaths were recorded. Of 3706 participants with T2DM, 2126 (57%) had known T2DM, 118 (3%) were identified by isolated elevated fasting glucose, 1022 (28%) had isolated elevated postload glucose, and 440 (12%) had both elevated fasting and postload glucose. Compared with normoglycemia, the hazard ratio (95% confidence interval) 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 4 groups, respectively. T2DM defined by elevated HbA1c was not significantly associated with all-cause mortality (hazard ratio, 1.17; 95% confidence interval, 0.81-1.69).
Conclusion
Individuals with isolated higher 2-h postload glucose had a higher risk of mortality by 43% than those with normoglycemia. Underuse of OGTT leads to substantial underdetection of individuals with a higher mortality risk and lost opportunities for early intervention.
Funder
Guangdong Natural Science Foundation
Guangzhou Science and Technology Bureau
Subject
Biochemistry (medical),Clinical Biochemistry,Endocrinology,Biochemistry,Endocrinology, Diabetes and Metabolism