Modulators of J-Shaped Association of HbA_1c Levels with Mortality in Adults

Low HbA_1c Levels and Mortality: The Story Is Not Over Yet…

“…In their well-written letter, Altay et al [1 ]describe a possible mechanism for the observed elevated risk of mortality in the group of patients with low levels of HbA 1c (<5%). This interesting association is the central focus of an ongoing debate, with data showing low levels of HbA 1c to have an important impact on patients' prognosis, while other data do not support this notion [2,3,4,5].…”

“…Mechanisms offered to explain these findings also include a high turnover of hemoglobin, a low BMI, and a higher inflammatory status [7,8], and Altay et al [1 ]further emphasize the inflammatory component by addressing the higher mortality rates in patients after cerebrovascular accident and in chronic kidney disease patients. We feel that while these explanations are appealing, they still do not complete the picture.…”