@article {10059, title = {Glycated hemoglobin and all-cause and cause-specific mortality among adults with and without diabetes.}, journal = {Journal of Clinical Endocrinology and Metabolism}, year = {2019}, abstract = {

CONTEXT: The patterns of associations between glycated hemoglobin (HbA1c) and mortality are still unclear.

OBJECTIVE: To explore the extent to which ranges of HbA1c levels are associated with the risk of mortality among participants with and without diabetes.

DESIGN: Setting and patients: This was a nationwide, community-based prospective cohort study. Included were 15,869 participants (median age 64 years) of the Health and Retirement Study, with available HbA1c data and without a history of cancer. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95\% confidential intervals (95\% CIs) for mortality.

RESULTS: A total of 2,133 participants died during a median follow-up of 5.8 years. In participants with diabetes, those with an HbA1c level of 6.5\% were at the lowest risk of all-cause mortality. When HbA1c level was lower than 5.6\% or higher than 7.4\%, the increased all-cause mortality risk became statistically significant as compared with an HbA1c level of 6.5\%. As for participants without diabetes, those with an HbA1c level of 5.4\% were at the lowest risk of all-cause mortality. When HbA1c level was lower than 5.0\%, the increased all-cause mortality risk became statistically significant as compared with an HbA1c level of 5.4\%. However, we did not observe a statistically significant elevated risk of all-cause mortality above an HbA1c level of 5.4\%.

CONCLUSIONS: A U-shaped and a reverse J-shaped association for all-cause mortality were found among participants with and without diabetes. The corresponding Optimal ranges for overall survival are predicted to be 5.6-7.4\% and 5.0-6.5\%, respectively.

}, keywords = {Biomarkers, Diabetes, Mortality}, issn = {1945-7197}, doi = {10.1210/jc.2018-02536}, author = {Li, Fu-Rong and Zhang, Xi-Ru and Zhong, Wen-Fang and Li, Zhi-Hao and Gao, Xiang and Virginia Byers Kraus and Lv, Yue-Bin and Zou, Meng-Chen and Chen, Guo-Chong and Chen, Pei-Liang and Zhang, Min-Yi and Kur, Akech Kuol Akech and Shi, Xiao-Ming and Wu, Xian-Bo and Mao, Chen} }