Chonnam Med J.  2017 Sep;53(3):223-228. 10.4068/cmj.2017.53.3.223.

Glycated Hemoglobin and All-Cause Mortality in Korean Type 2 Diabetes

• An MS
• Kim SA
• Lee JH
• Choi SW
• Shin MH

• KMID: 2390437
• DOI: http://doi.org/10.4068/cmj.2017.53.3.223

Abstract

The purpose of this study was to evaluate the association between glycated hemoglobin (HbA1c) and all-cause mortality in type 2 diabetes mellitus. We conducted a community-based prospective cohort study of 352 type 2 diabetic patients aged 30-92 who participated in a community diabetes complications screening program in Gokseng-gun, Jeollanamdo, Korea. HbA1c levels were categorized as <6.5%, 6.5-6.9%, 7.0-7.9%, 8.0-8.9% and ≥9.0%. Patients were followed up on for a mean of 6.9 years. The Cox proportional hazards model was used to evaluate the relationship between HbA1c levels and all-cause mortality. During the mean follow-up period of 6.9 years, 77 patients (21.9%) died. A J-shaped association was found between HbA1c and all-cause mortality, with the lowest mortality at 6.5-6.9% of HbA1c levels. Compared to patients with HbA1c of 6.5-6.9%, patients with <6.5%, 7.0-7.9%, 8.0-8.9% and ≥9.0% had an adjusted hazard ratio (95% confidence interval) for all-cause mortality of 1.71 (0.76-3.84), 1.23 (0.53-2.82), 1.32(0.51-3.44) and 2.66 (1.01-7.02), respectively. We found a J-shaped association between glycated hemoglobin and all-cause mortality in Korean type 2 diabetic patients.

Keyword

Diabetes Mellitus; Cohort Studies; Hemoglobin A, Glycosylated; Death

MeSH Terms

Cohort Studies
Diabetes Complications
Diabetes Mellitus
Diabetes Mellitus, Type 2
Follow-Up Studies
Hemoglobin A, Glycosylated*
Humans
Jeollanam-do
Korea
Mass Screening
Mortality*
Proportional Hazards Models
Prospective Studies
Hemoglobin A, Glycosylated

Figure

• 

  FIG. 1 Age- and sex-adjusted all-cause mortality rate according to glycated hemoglobin categories (/100 person-years).

Reference

1. World Health Organization. Global report on diabetes. Geneva, Switzerland: World Health Organization;2016.

2. Ha KH, Kim DJ. Trends in the diabetes epidemic in Korea. Endocrinol Metab (Seoul). 2015; 30:142–146.

3. Organisation for Economic Co-operation and Development. Health at a glance : Asia/Pacific, 2010. Paris: OECD Publishing;2010.

4. Diabetes Control and Complications Trial Research Group. Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329:977–986.

5. Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA, et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000; 321:412–419.

6. Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005; 353:2643–2653.

7. American Diabetes Association. Standards of medical care in Diabetes-2016 abridged for primary care providers. Clin Diabetes. 2016; 34:3–21.

8. Zhang Y, Hu G, Yuan Z, Chen L. Glycosylated hemoglobin in relationship to cardiovascular outcomes and death in patients with type 2 diabetes: a systematic review and meta-analysis. PLoS One. 2012; 7:e42551.

9. Huang ES, Liu JY, Moffet HH, John PM, Karter AJ. Glycemic control, complications, and death in older diabetic patients: the diabetes and aging study. Diabetes Care. 2011; 34:1329–1336.

10. Currie CJ, Peters JR, Tynan A, Evans M, Heine RJ, Bracco OL, et al. Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet. 2010; 375:481–489.

11. Schoenaker DA, Simon D, Chaturvedi N, Fuller JH, Soedamah-Muthu SS. EURODIAB Prospective Complications Study Group. Glycemic control and all-cause mortality risk in type 1 diabetes patients: the EURODIAB prospective complications study. J Clin Endocrinol Metab. 2014; 99:800–807.

12. Choi SW, Shin MH, Yun WJ, Kim HY, Lee YH, Kweon SS, et al. Association between hemoglobin A1c, carotid atherosclerosis, arterial stiffness, and peripheral arterial disease in Korean type 2 diabetic patients. J Diabetes Complications. 2011; 25:7–13.

13. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130:461–470.

14. Action to Control Cardiovascular Risk in Diabetes Study Group. Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008; 358:2545–2559.

15. Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009; 360:129–139.

16. ADVANCE Collaborative Group. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008; 358:2560–2572.

17. Goto A, Arah OA, Goto M, Terauchi Y, Noda M. Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. BMJ. 2013; 347:f4533.

18. Lipska KJ, Warton EM, Huang ES, Moffet HH, Inzucchi SE, Krumholz HM, et al. HbA1c and risk of severe hypoglycemia in type 2 diabetes: the diabetes and aging study. Diabetes Care. 2013; 36:3535–3542.

19. Carson AP, Fox CS, McGuire DK, Levitan EB, Laclaustra M, Mann DM, et al. Low hemoglobin A1c and risk of all-cause mortality among US adults without diabetes. Circ Cardiovasc Qual Outcomes. 2010; 3:661–667.

20. Greenfield S, Billimek J, Pellegrini F, Franciosi M, De Berardis G, Nicolucci A, et al. Comorbidity affects the relationship between glycemic control and cardiovascular outcomes in diabetes: a cohort study. Ann Intern Med. 2009; 151:854–860.

21. de Vegt F, Dekker JM, Ruhé HG, Stehouwer CD, Nijpels G, Bouter LM, et al. Hyperglycaemia is associated with all-cause and cardiovascular mortality in the Hoorn population: the Hoorn study. Diabetologia. 1999; 42:926–931.

22. Selvin E, Steffes MW, Zhu H, Matsushita K, Wagenknecht L, Pankow J, et al. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med. 2010; 362:800–811.

23. Paprott R, Schaffrath Rosario A, Busch MA, Du Y, Thiele S, Scheidt-Nave C, et al. Association between hemoglobin A1c and all-cause mortality: results of the mortality follow-up of the German National Health Interview and Examination Survey 1998. Diabetes Care. 2015; 38:249–256.