Medical Research Council Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Box 285, Hills Road, Cambridge, CB2 0QQ, UK.
Diabetologia. 2011 Aug;54(8):2025-32. doi: 10.1007/s00125-011-2162-0. Epub 2011 May 17.
AIMS/HYPOTHESIS: There is debate about increased mortality risk associated with low levels of glycaemia. To address this issue, we examined the shape of the risk relationship between glycated haemoglobin and mortality in a UK population.
In 17,196 men and women aged 39-82 years participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study in Norfolk without known diabetes or cardiovascular disease, we estimated HRs for total and cause-specific mortality comparing categories of glycated haemoglobin (<4.5%, 4.5% to <5.0%, 5.0% to <5.5% [reference], 5.5% to <6.0%, 6.0% to <6.5%, and ≥6.5%) using Cox regression.
During a mean (±SD) follow-up of 11.2 (±2.1) years 1,953 participants died. The HR for all-cause mortality increased with categories of increasing glycated haemoglobin in adjusted analyses (HR 0.94 [95% CI 0.72-1.22], 0.99 [0.86-1.13], 1.00 [0.92-1.08], 1.10 [1.02-1.19], 1.29 [1.14-1.46] and 1.45 [1.16-1.80]). Spline regression suggested no increased risk at the low end of the distribution. Indeed, the HR for all-cause mortality was virtually constant in the low range and only started to rise when the level was approximately 5.5%. There were similar associations of glycated haemoglobin with cause-specific mortality, with the strongest association being seen for cardiovascular mortality.
CONCLUSIONS/INTERPRETATION: Our findings in a large non-diabetic population do not support the concern about increased mortality risk with low glycated haemoglobin. Differences in population characteristics might explain contrary results of earlier studies and need further exploration.
目的/假设：关于低血糖与死亡率升高之间存在争议。为了解决这个问题，我们在英国人群中研究了糖化血红蛋白与死亡率之间的风险关系的形状。
在没有已知糖尿病或心血管疾病的 17196 名年龄在 39-82 岁的男性和女性中，我们使用 Cox 回归比较了糖化血红蛋白的不同类别（<4.5%、4.5%至<5.0%、5.0%至<5.5%[参考]、5.5%至<6.0%、6.0%至<6.5%和≥6.5%）与全因和死因特异性死亡率的 HR。
在平均（±标准差）11.2（±2.1）年的随访期间，有 1953 名参与者死亡。在调整分析中，所有原因死亡率随着糖化血红蛋白类别的增加而增加（HR 0.94[95%CI 0.72-1.22]、0.99[0.86-1.13]、1.00[0.92-1.08]、1.10[1.02-1.19]、1.29[1.14-1.46]和 1.45[1.16-1.80]）。样条回归表明在分布的低端没有增加的风险。实际上，在低范围，全因死亡率的 HR 几乎保持不变，只有当水平约为 5.5%时才开始上升。糖化血红蛋白与死因特异性死亡率也有类似的关联，其中心血管死亡率的关联最强。
结论/解释：我们在一个大型非糖尿病人群中的发现不支持低血糖与死亡率升高风险增加的担忧。人群特征的差异可能解释了早期研究的相反结果，需要进一步探索。
