Predictive Value of Fasting Glucose, Postload Glucose, and Hemoglobin A1c on Risk of Diabetes and Complications in Chinese Adults

Author:

Lu Jieli1,He Jiang2,Li Mian1,Tang Xulei3,Hu Ruying4,Shi Lixin5,Su Qing6,Peng Kui1,Xu Min1ORCID,Xu Yu1,Chen Yuhong1,Yu Xuefeng7ORCID,Yan Li8,Wang Tiange1,Zhao Zhiyun1,Qin Guijun9,Wan Qin10,Chen Gang11,Dai Meng1,Zhang Di1,Gao Zhengnan12,Wang Guixia13,Shen Feixia14,Luo Zuojie15ORCID,Qin Yingfen15ORCID,Chen Li16,Huo Yanan17,Li Qiang18,Ye Zhen4,Zhang Yinfei19,Du Rui1,Cheng Di1,Liu Chao20,Wang Youmin21,Wu Shengli22,Yang Tao23ORCID,Deng Huacong24,Li Donghui25,Lai Shenghan26,Bloomgarden Zachary T.27ORCID,Chen Lulu28ORCID,Zhao Jiajun29ORCID,Mu Yiming30ORCID,Ning Guang1ORCID,Wang Weiqing1ORCID,Bi Yufang1ORCID

Affiliation:

1. Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine Tumors of Ministry of Shanghai, Shanghai Institute for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

2. Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA

3. The First Hospital of Lanzhou University, Lanzhou, China

4. Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China

5. Affiliated Hospital of Guiyang Medical College, Guiyang, China

6. Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China

7. Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

8. Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

9. The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

10. The Affiliated Hospital of Southwest Medical University, Luzhou, China

11. Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China

12. Dalian Municipal Central Hospital, Dalian, China

13. The First Hospital of Jilin University, Changchun, China

14. The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

15. The First Affiliated Hospital of Guangxi Medical University, Nanning, China

16. Qilu Hospital of Shandong University, Jinan, China

17. Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, China

18. The Second Affiliated Hospital of Harbin Medical University, Harbin, China

19. Central Hospital of Shanghai Jiading District, Shanghai, China

20. Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China

21. The First Affiliated Hospital of Anhui Medical University, Hefei, China

22. Karamay Municipal People’s Hospital, Xinjiang, China

23. The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

24. The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

25. Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX

26. Johns Hopkins University School of Medicine, Baltimore, MD

27. Icahn School of Medicine at Mount Sinai, New York, NY

28. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

29. Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China

30. Chinese People’s Liberation Army General Hospital, Beijing, China

Abstract

OBJECTIVE Uncertainty remains regarding the predictive value of various glycemic measures as they relate to the risk of diabetes and its complications. Using the cutoffs recommended by the American Diabetes Association’s 2010 criteria, we determined the associations of fasting plasma glucose (FPG), 2-h postload glucose (2h-PG), and HbA1c with the outcomes. RESEARCH DESIGN AND METHODS Baseline medical history, FPG, 2h-PG, and HbA1c were obtained from a population-based cohort of 193,846 adults aged ≥40 years in China during 2011–2012. A follow-up visit was conducted during 2014–2016 in order to assess incident diabetes, cardiovascular disease (CVD), cancer, and mortality. RESULTS We documented 8,063 cases of diabetes, 3,014 CVD-related events, 1,624 cases of cancer, and 2,409 deaths during up to 5 years of follow-up. Multivariable-adjusted risk ratios (95% CIs) of diabetes associated with prediabetes based on FPG of 100–125 mg/dL, 2h-PG of 140–199 mg/dL, or HbA1c of 5.7–6.4% (39–47 mmol/mol) were 1.60 (1.43–1.79), 2.72 (2.43–3.04), and 1.49 (1.36–1.62), respectively. Restricted cubic spline analyses suggested J-shaped associations of FPG, 2h-PG, and HbA1c levels with CVD, cancer, and mortality. Multivariable-adjusted hazard ratios (95% CIs) associated with untreated diabetes based on FPG ≥126 mg/dL, 2h-PG ≥200 mg/dL, or HbA1c ≥6.5% (48 mmol/mol) were 1.18 (1.05–1.33), 1.31 (1.18–1.45), and 1.20 (1.07–1.34) for CVD; 1.10 (0.92–1.32), 1.44 (1.25–1.67), and 1.08 (0.92–1.28) for cancer; and 1.37 (1.20–1.57), 1.57 (1.41–1.76), and 1.33 (1.17–1.52) for mortality, respectively. 2h-PG remained significantly associated with outcomes in models including FPG and HbA1c as spline terms. Furthermore, 2h-PG significantly improved the ability of the C statistic to predict diabetes, CVD, and mortality. CONCLUSIONS 2h-PG remains independently predictive of outcomes in models including FPG and HbA1c. Therefore, in addition to FPG and HbA1c, routine testing of 2h-PG should be considered in order to better assess the risks of outcomes.

Funder

National Basic Research Program of China

Ministry of Science and Technology of the People’s Republic of China

National Natural Science Foundation of China

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3