Continuous relationships between non-diabetic hyperglycaemia and both cardiovascular disease and all-cause mortality: the Australian Diabetes, Obesity, and Lifestyle (AusDiab) study

Abstract

Aims/hypothesis Hyperglycaemia is a risk factor for cardiovascular disease (CVD) and all-cause mortality in individuals without diabetes. We investigated: (1) whether the risk of allcause and CVD mortality extended continuously throughout the range of fasting plasma glucose (FPG), 2 h plasma glucose (2hPG) and HbA 1c values; and (2) the ability of these measures to improve risk prediction for mortality. Methods Data on 10,026 people aged ≥25 years without diagnosed diabetes were obtained from the population-based Australian Diabetes, Obesity and Lifestyle study. Between 1999 and 2000, FPG, 2hPG and HbA 1c were assessed and allcause (332 deaths) and CVD (88 deaths) mortality were obtained after 7 years. Results Both 2hPG and HbA 1c exhibited linear relationships with all-cause and CVD mortality, whereas FPG showed Jshaped relationships. The adjusted HR (95% CI) for all-cause mortality per SD increase was 1.2 (1.1-1.3) for 2hPG and 1.1 (1.0-1.2) for HbA 1c . The HR for FPG <5.1 mmol/l (per SD decrease) was 2.0 (1.3-3.0); for FPG ≥5.1 mmol/l (per SD increase) the HR was 1.1 (1.0-1.2). Corresponding HRs for CVD mortality were 1.2 (1.0-1.4), 1.2 (1.0-1.3), 4.0 (2.1-7.6) and 1.3 (1.1-1.4). The discriminative ability of each measure was similar; no measure substantially improved individual risk identification over traditional risk factors. Conclusions/interpretation In individuals without diagnosed diabetes, 2hPG and FPG, but not HbA 1c were significant predictors of all-cause mortality, whereas all measures were significant predictors of CVD mortality. However, these glucose measures did not substantially improve individual risk identification.

HbA1c as predictor of all-cause mortality in individuals at high risk of diabetes with normal glucose tolerance, identified by screening: a follow-up study of the Anglo–Danish–Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION), Denmark

“…Individuals with NGT, but with HbA 1c at 6.5% or above, and at high risk of diabetes had substantially increased all-cause mortality. Although, due to the low number of individuals with HbA 1c at 6.5% or above, our results are subject to some uncertainty, they do support previous findings of chronic hyperglycaemia being harmful [5,13,14] and also stress the significance of HbA 1c levels in the identification of risk groups. Carotid intima-media thickness is a well-established index of early atherosclerosis and is widely used as surrogate marker of cardiovascular disease [15].…”

Diabetes patients and non-diabetic patients intensive care unit and hospital mortality risks associated with sepsis

“…cardiovascular mortality and all cause mortality [1,2] . For example, a mean fasting blood glucose of 104.5 mg/dL was associated with a 1.19 odds ratio (OR) for all cause mortality (1.05-1.35, P �� 0.05) �� 0.05) [1] .…”

Assessment of the left ventricular function in normotensive prediabetics: a tissue Doppler echocardiography study

“…Although individuals can spend years in prediabetic stage, an expert American Diabetes Association (ADA) panel estimated that up to 70% of individuals with prediabetes (preDM) will eventually progress to type 2 diabetes (3). For this reason, preDM is considered a substantial risk factor for diabetes and is associated with microvascular complications and cardiovascular disease in a way similar to diabetes mellitus (DM) (4,5). It is associated with an approximately 20% increased risk of developing cardiovascular disease compared with normoglycemic subjects.…”