@article {Vermunte002495, author = {Jane Vermunt and Fiona Bragg and Jim Halsey and Ling Yang and Yiping Chen and Yu Guo and Huaidong Du and Fanwen Meng and Pei Pei and Canqing Yu and Jun Lv and Junshi Chen and Liming Li and Sarah Lewington and Zhengming Chen}, editor = {,}, title = {Random plasma glucose levels and cause-specific mortality among Chinese adults without known diabetes: an 11-year prospective study of 450,000 people}, volume = {9}, number = {2}, elocation-id = {e002495}, year = {2021}, doi = {10.1136/bmjdrc-2021-002495}, publisher = {BMJ Specialist Journals}, abstract = {Introduction We examined the associations between long-term usual random plasma glucose (RPG) levels and cause-specific mortality risks among adults without known diabetes in China.Research design and methods The China Kadoorie Biobank recruited 512,891 adults (59\% women) aged 30{\textendash}79 from 10 regions of China during 2004{\textendash}2008. At baseline survey, and subsequent resurveys of a random subset of survivors, participants were interviewed and measurements collected, including on-site RPG testing. Cause of death was ascertained via linkage to local mortality registries. Cox regression yielded adjusted HR for all-cause and cause-specific mortality associated with usual levels of RPG.Results During median 11 years{\textquoteright} follow-up, 37,214 deaths occurred among 452,993 participants without prior diagnosed diabetes or other chronic diseases. There were positive log-linear relationships between RPG and all-cause, cardiovascular disease (CVD) (n=14,209) and chronic kidney disease (CKD) (n=432) mortality down to usual RPG levels of at least 5.1 mmol/L. At RPG \<11.1 mmol/L, each 1.0 mmol/L higher usual RPG was associated with adjusted HRs of 1.14 (95\% CI 1.12 to 1.16), 1.16 (1.12 to 1.19) and 1.44 (1.22 to 1.70) for all-cause, CVD and CKD mortality, respectively. Usual RPG was positively associated with chronic liver disease (n=547; 1.45 (1.26 to 1.66)) and cancer (n=12,680; 1.12 (1.09 to 1.16)) mortality, but with comparably lower risks at baseline RPG >=11.1 mmol/L. These associations persisted after excluding participants who developed diabetes during follow-up.Conclusions Among Chinese adults without diabetes, higher RPG levels were associated with higher mortality risks from several major diseases, with no evidence of apparent thresholds below the cut-points for diabetes diagnosis.Data are available upon reasonable request. The China Kadoorie Biobank (CKB) is a global resource for the investigation of lifestyle, environmental, blood biochemical and genetic factors as determinants of common diseases. The CKB study group is committed to making the cohort data available to the scientific community in China, the UK and worldwide to advance knowledge about the causes, prevention and treatment of disease. For detailed information on what data is currently available to open access users and how to apply for it, visit: http://www.ckbiobank.org/site/Data+Access.Researchers who are interested in obtaining the raw data from the China Kadoorie Biobank study that underlines this paper should contact ckbaccess{at}ndph.ox.ac.uk. A research proposal will be requested to ensure that any analysis is performed by bona fide researchers and - where data is not currently available to open access researchers - is restricted to the topic covered in this paper.}, URL = {https://drc.bmj.com/content/9/2/e002495}, eprint = {https://drc.bmj.com/content/9/2/e002495.full.pdf}, journal = {BMJ Open Diabetes Research and Care} }