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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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