Recent HbA1c Values and Mortality Risk in Type 2 Diabetes. Population-Based Case-Control Study


Nicholas, J; Charlton, J; Dregan, A; Gulliford, MC; (2013) Recent HbA1c Values and Mortality Risk in Type 2 Diabetes. Population-Based Case-Control Study. PLoS One, 8 (7). ISSN 1932-6203 DOI: https://doi.org/10.1371/journal.pone.0068008

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Abstract

This study aimed to evaluate mortality within 365 days of HbA1c values of <6.5% or >9.0% in participants with clinical type 2 diabetes mellitus. A matched nested case-control study was implemented, within a cohort of participants with type 2 diabetes from 2000 to 2008. Conditional logistic regression was used to model the odds ratio for mortality adjusting for comorbidity and drug utilisation. There were 97,450 participants with type 2 diabetes; 16,585 cases that died during follow up were matched to 16,585 controls. The most recent HbA1c value was <6.5% (48 mmol/mol) for 22.2% of cases and 24.2% of controls, the HbA1c was >9.0% for 9.0% of cases and 7.7% of controls. In a complete case analysis, the adjusted odds ratio (AOR) for mortality associated with most recent HbA1c <6.5% was 1.31 (95% confidence interval (CI): 1.21,1.42). After multiple imputation of missing HbA1c values the AOR was 1.20 (CI: 1.12,1.28). The complete case analysis gave an AOR for HbA1c >9.0% of 1.51 (CI: 1.33, 1.70), in the multiple imputation analysis this was 1.29 (1.17,1.41). The risk associated with HbA1c <6.5% was age dependent. In the multiple imputation analysis the AOR was 1.53 (CI: 0.84 to 2.79) at age<55 years but 1.04 (CI: 0.92, 1.17) at age 85 years and over. In non-randomised data, values of HbA1c that are either <6.5% or >9.0% may be associated with increased mortality within one year in clinical type 2 diabetes. Relative risks may be higher at younger ages.

Item Type: Article
Keywords: all-cause mortality, randomized controlled-trials, blood-glucose, control, vascular complications, cardiovascular death, sulfonylurea, drugs, glycemic control, hemoglobin a1c, follow-up, metaanalysis
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Faculty of Epidemiology and Population Health > Dept of Medical Statistics
PubMed ID: 23861845
Web of Science ID: 321425300035
URI: http://researchonline.lshtm.ac.uk/id/eprint/1229376

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