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Categories of glucose tolerance and continuous glycemic measures and mortality

  • DIABETES MELLITUS
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Abstract

We investigated the association of undiagnosed diabetes, previously known diabetes and prediabetes (WHO 1999 classification) with all-cause and cause-specific mortality in an older German population. Previous study results for mortality in patients with very low levels of HbA1c, fasting plasma glucose (FPG), and 2-h plasma glucose (2hPG) are still inconclusive. Thus we have extended the analyses to continuous measures of glycemia. A total of 1,466 subjects aged 55–74 years from the population-based KORA survey S4 (conducted from 1999 to 2001) were included in our observational mortality study (152 subjects with previously known diabetes, and 1,314 further subjects who underwent oral glucose tolerance tests). Mortality was followed up for a maximum of 10.0 years (median follow-up 8.8 years). A total of 180 (12.3%) of the 1,466 subjects have died during the follow-up period. The age- and sex-adjusted hazard ratios for all-cause mortality were 2.6 (95%CI, 1.7–3.8) for known diabetes, 2.8 (95%CI, 1.7–4.4) for undiagnosed diabetes, and 1.1 (95%CI, 0.8–1.7) for prediabetes [reference: normal glucose tolerance (NGT)]. After multivariable adjustment, undiagnosed diabetes was associated with 3.0-fold increased cancer mortality, 1.1-fold increased cardiovascular mortality, and 4.7-fold increased non-cancer, non-cardiovascular mortality compared with NGT. For HbA1c, FPG, and 2hPG, J-shaped associations with all-cause mortality were observed. Undiagnosed diabetes is associated with increased all-cause, cancer, and non-cancer non-cardiovascular mortality, but not with cardiovascular mortality in this older population. All-cause mortality in undiagnosed diabetes is similar to that in previously known diabetes but much higher than mortality in prediabetes and NGT.

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Abbreviations

BMI:

Body mass index

CI:

Confidence interval

CVD:

Cardiovascular disease

DECODE:

Diabetes epidemiology: collaborative analysis of diagnostic criteria in Europe

FPG:

Fasting plasma glucose

HDL:

High-density lipoprotein

HOMA-IR:

Homeostatic model assessment of insulin resistance

HR:

Hazard ratio

ICD:

International classification of diseases

IDI:

Integrated discrimination improvement

IFG:

Impaired fasting glucose

IGT:

Impaired glucose tolerance

KORA:

Cooperative health research in the region of Augsburg

NGT:

Normal glucose tolerance

NHANES:

National Health and Nutrition Examination Survey

NRI:

Net reclassification improvement

OGTT:

Oral glucose tolerance test

PY:

Person-year

2hPG:

2-h plasma glucose

WHO:

World Health Organization

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Acknowledgments

The Diabetes Cohort Study was funded by a German Research Foundation project grant to the first author (DFG; RA 459/2-1). The German Diabetes Center is funded by the German Federal Ministry of Health and the Ministry of Innovation, Science, Research and Technology of the federal state of North Rhine Westfalia. The KORA research platform and the KORA Augsburg studies are financed by the Helmholtz Zentrum München, German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education, Science, Research and Technology and by the State of Bavaria. We thank the field staff in Augsburg who was involved in conducting the studies. Cornelia Huth was supported by a grant from the German Federal Ministry of Education and Research (BMBF) to the German Center for Diabetes Research (DZD e.V.).

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Authors and Affiliations

  1. Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf´m Hennekamp 65, 40225, Düsseldorf, Germany

    Bernd Kowall, Wolfgang Rathmann, Guido Giani & Andrea Icks

  2. Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, Neuherberg, Germany

    Margit Heier, Annette Peters, Barbara Thorand, Cornelia Huth & Christine Meisinger

  3. Department of Public Health, Faculty of Medicine, Heinrich Heine University, Düsseldorf, Germany

    Andrea Icks

Authors
  1. Bernd Kowall
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  2. Wolfgang Rathmann
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  3. Margit Heier
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  4. Guido Giani
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  5. Annette Peters
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  6. Barbara Thorand
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  7. Cornelia Huth
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  8. Andrea Icks
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  9. Christine Meisinger
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Correspondence to Bernd Kowall.

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Bernd Kowall and Wolfgang Rathmann contributed equally to the manuscript.

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Kowall, B., Rathmann, W., Heier, M. et al. Categories of glucose tolerance and continuous glycemic measures and mortality. Eur J Epidemiol 26, 637–645 (2011). https://doi.org/10.1007/s10654-011-9609-y

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  • DOI: https://doi.org/10.1007/s10654-011-9609-y

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