Postload Plasma Glucose and 30-Year Mortality Among Nondiabetic Middle-Aged Men From the General Population: The ERFORT Study

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Purpose

The purpose of the study is to examine for the first time the association between 1-hour postload plasma glucose levels and known diabetes and 30-year total mortality.

Methods

The population-based Erfurt Male Cohort Study of 1160 men aged 40 to 59 years was carried out between September 1973 and August 1975. A 1-hour postload venous blood sample was obtained after an oral glucose tolerance test in all nondiabetic subjects. Mortality follow-up continued until death or September 30, 2003.

Results

Only 25 subjects were lost to follow-up, but 595 study participants (51.3%) died. Survival curves for persons with diabetes, subjects with postload glucose levels greater than 200 mg/dL, and those with not elevated levels already start to diverge after 2 years in persons with diabetes, but only after 5 years in subjects with high postload glucose levels. After 30 years of follow-up, men with diabetes had an almost twofold risk for death (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.26–2.97) and men with a postload plasma glucose level greater than 200 mg/dL had a 1.5-fold increased risk for death (HR, 1.49; 95% CI, 1.17–1.88) compared with men in the lower-glucose-level group, even after multivariable adjustment.

Conclusions

Postload hyperglycemia is a long-term predictor for all-cause mortality in middle-aged men without diabetes from the general population.

Introduction

Prior studies showed that subjects with type 2 diabetes had an increased risk for total mortality and coronary heart disease morbidity and mortality 1, 2. Panzram (1) reported that age- and sex-related overall mortality rates of patients with type 2 diabetes are approximately twice as high as those of individuals without diabetes. Since 1980, a number of studies investigated the relationship of postchallenge hyperglycemia and mortality 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 in initially nondiabetic subjects. In general, these studies found an increased risk for death with increasing postchallenge glucose levels compared with normal levels. However, most studies investigating this association were performed in specific groups of subjects, for example, in employed men 4, 7, or were based on follow-up periods less than 10 years 5, 10. To the best of our knowledge, to date, only one single population-based study investigated glucose intolerance and 23-year risk for total mortality (8), and no additional data on the predictive ability of postload plasma glucose level on long-term mortality greater than 20 years in subjects without diabetes from the general population are available. The present study enables us to examine for the first time the relationship of postload plasma glucose levels and diabetes with 30-year total mortality in middle-aged men from the general population.

Section snippets

Methods

The presented data were derived from the population-based Erfurt Male Cohort Study (ERFORT), a cohort study of men aged 40 to 59 years at recruitment. The design of the study and measurement procedures were published elsewhere (13). Briefly, using the residential registry (Adress-Maschine) in spring 1973, a random population sample of 1600 men, approximately 6% of the total male population aged 40 to 59 years, was drawn from Erfurt, the capital of the state Thueringen, Germany. Subjects were

Results

During the average 30 years of follow-up, 1125 nondiabetic men with an oral glucose tolerance test contributed 25,923 total person-years. At baseline, their average age was 48.1 years (SD = 5.7), and average postload plasma glucose level was 142.0 mg/dL (SD = 49.4). Table 1 lists baseline characteristics of this population by postload plasma glucose category and diabetes. Mean age and blood pressure increased with greater plasma glucose levels and were greatest in persons with diabetes. In the

Discussion

The present study investigates for the first time the association between postload plasma glucose level and known diabetes and total mortality in middle-aged German men for a follow-up of 30 years. The present findings confirm that men with diabetes have an almost twofold risk for death independent of other risk factors (1) and show that this risk remains unchanged up to 30 years after baseline examination. Furthermore, risk for death from all causes for men with postload glycemia with a

References (22)

  • B.L. Rodriguez et al.

    Glucose intolerance and 23-year risk of coronary heart disease and total mortality: The Honolulu Heart Program

    Diabetes Care

    (1999)
  • Cited by (0)

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