Weiqin Li1, Peter T Katzmarzyk2, Ronald Horswell2, Yujie Wang2, Jolene Johnson3, Gang Hu4. 1. Pennington Biomedical Research Center, Baton Rouge, LA, USA; Tianjin Women's and Children's Health Center, Tianjin, China. 2. Pennington Biomedical Research Center, Baton Rouge, LA, USA. 3. Louisiana State University Health Center, Baton Rouge, LA, USA. 4. Pennington Biomedical Research Center, Baton Rouge, LA, USA. Electronic address: gang.hu@pbrc.edu.
Abstract
BACKGROUND: Several prospective studies have evaluated the association between glycosylated hemoglobin (HbA1c) and death risk among diabetic patients. However, the results have been inconsistent. METHODS: We performed a prospective study which included 13,334 men and 21,927 women with type 2 diabetes. Cox proportional hazards regression models were used to estimate the association of different levels of HbA1c with all-cause mortality. RESULTS: During a mean follow up of 8.7 years, 4199 (2082 men and 2117 women) patients died. The multivariable-adjusted hazard ratios (HRs) of all-cause mortality associated with different levels of HbA1c at baseline (<6.0%, 6.0-6.9% [reference], 7.0-7.9, 8.0-8.9%, 9.0-9.9%, 10.0-10.9%, and ≥11.0%) were 1.06, 1.00, 1.10, 0.93, 1.26, 1.18 and 1.31 (Pnon-linear=0.008) for men, and 1.21, 1.00, 1.01, 1.08, 1.30, 1.30 and 1.74 (Pnon-linear<0.001) for women, respectively. The J-shaped association of HbA1c with all-cause mortality was confirmed among African American and white diabetic patients, patients who were more than 50 years old, never smoked or used insulin. When we used an updated mean value of HbA1c, the J-shaped association of HbA1c with the risk of all-cause mortality did not change. CONCLUSIONS: Our study demonstrated a J-shaped association between HbA1c and the risk of all-cause mortality among men and women with type 2 diabetes. Both high and low levels of HbA1c were associated with an increased risk of all-cause mortality.
BACKGROUND: Several prospective studies have evaluated the association between glycosylated hemoglobin (HbA1c) and death risk among diabeticpatients. However, the results have been inconsistent. METHODS: We performed a prospective study which included 13,334 men and 21,927 women with type 2 diabetes. Cox proportional hazards regression models were used to estimate the association of different levels of HbA1c with all-cause mortality. RESULTS: During a mean follow up of 8.7 years, 4199 (2082 men and 2117 women) patients died. The multivariable-adjusted hazard ratios (HRs) of all-cause mortality associated with different levels of HbA1c at baseline (<6.0%, 6.0-6.9% [reference], 7.0-7.9, 8.0-8.9%, 9.0-9.9%, 10.0-10.9%, and ≥11.0%) were 1.06, 1.00, 1.10, 0.93, 1.26, 1.18 and 1.31 (Pnon-linear=0.008) for men, and 1.21, 1.00, 1.01, 1.08, 1.30, 1.30 and 1.74 (Pnon-linear<0.001) for women, respectively. The J-shaped association of HbA1c with all-cause mortality was confirmed among African American and white diabeticpatients, patients who were more than 50 years old, never smoked or used insulin. When we used an updated mean value of HbA1c, the J-shaped association of HbA1c with the risk of all-cause mortality did not change. CONCLUSIONS: Our study demonstrated a J-shaped association between HbA1c and the risk of all-cause mortality among men and women with type 2 diabetes. Both high and low levels of HbA1c were associated with an increased risk of all-cause mortality.
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