Association between glycated hemoglobin and risk of all‐cause mortality in community patients with type 2 diabetes: A prospective cohort study

• Published in: Journal of diabetes investigation Vol. 15; no. 7; pp. 939 - 945
• Main Authors: He, Qingfang, Gao, Mingfei, Zhou, Xiaoyan, Wang, Lixin, Fang, Yujia, Hu, Ruying
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.07.2024; John Wiley and Sons Inc; Wiley
• Subjects: Age; Aged; Blood pressure; Body mass index; Cause of Death; China - epidemiology; Cholesterol; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - mortality; Drugs; Female; Follow-Up Studies; Gender; Glucose; Glycated Hemoglobin - analysis; Glycosylated hemoglobin; Health services; Hemoglobin; High density lipoprotein; Humans; Hypertension; Lipoproteins; Male; Metabolic disorders; Middle Aged; Mortality; Mortality - trends; Mortality risk; Normal distribution; Obesity; Original; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Factors; Rural Population - statistics & numerical data; Smoking; Software; Statistical analysis; Surveillance; Type 2 diabetes mellitus; China; United States > US; Zhejiang China; Glycosylated hemoglobin; Mortality risk; Type 2 diabetes mellitus
• ISSN: 2040-1116; 2040-1124; 2040-1124
• DOI: 10.1111/jdi.14183

ABSTRACT Aims/Introduction To analyze the association between HbA1c level and the risk of all‐cause mortality in community patients with type 2 diabetes mellitus, and to provide a scientific basis for the management of type 2 diabetes mellitus in the community. Materials and Methods Based on a Zhejiang rural community type 2 diabetes mellitus cohort, a total of 10,310 patients with type 2 diabetes mellitus with complete baseline and follow‐up data were selected. The Cox proportional hazards regression model and the restricted cubic spline model were used to evaluate the relationship between the HbA1c level and the risk of all‐cause mortality. Results During a mean follow‐up of 5.5 years, 971 patients died. With HbA1c levels of 6.5–7.0% as the reference, after adjusting for relevant confounding factors, the HR(95%CI) of all‐cause mortality with HbA1c levels of <5.5%, 5.5–6.5%, 7.0–8.0%, 8.0–9.0%, and ≥9.0% were 1.53 (1.08–2.15), 0.97 (0.79–1.21), 1.14 (0.92–1.41), 1.44 (1.14–1.83), and 2.08 (1.68–2.58), respectively. The HbA1c level was associated with the risk of all‐cause mortality in a “J‐shaped” manner. The risk of all‐cause mortality was lowest when the HbA1c was 6.5–7.0%, and increased significantly when the HbA1c was ≥ 8.0% and the HbA1c was < 5.5% (P < 0.05). The risk of all‐cause death in the HbA1c 5.5–6.5% group and the 7.0–8.0% group was not significant compared with the reference group (P > 0.05). Conclusions The HbA1c levels were associated with the risk of all‐cause mortality in type 2 diabetes mellitus in a “J‐shaped” manner, a too high or a too low HbA1c level could increase the risk of death. Attention should be paid to the individual evaluation of patients and the setting of appropriate glycemic control goals. To analyze the association between the HbA1c level and the risk of all‐cause mortality in community patients with type 2 diabetes mellitus through a prospective cohort study.