Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Germany.
Eur J Epidemiol. 2011 Aug;26(8):637-45. doi: 10.1007/s10654-011-9609-y. Epub 2011 Jul 23.
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.
我们研究了在德国老年人群中，未诊断的糖尿病、已知的糖尿病和糖尿病前期（根据 1999 年世界卫生组织分类）与全因死亡率和死因特异性死亡率之间的关系。之前的研究结果对于糖化血红蛋白（HbA1c）、空腹血浆葡萄糖（FPG）和 2 小时血浆葡萄糖（2hPG）水平非常低的患者的死亡率仍然没有定论。因此，我们将分析扩展到血糖的连续测量上。我们的观察性死亡率研究纳入了来自基于人群的 KORA 调查 S4（1999 年至 2001 年进行）的 1466 名年龄在 55-74 岁的受试者（152 名已知患有糖尿病的受试者和 1314 名接受口服葡萄糖耐量试验的进一步受试者）。死亡率的随访时间最长为 10.0 年（中位随访时间为 8.8 年）。在随访期间，共有 180 名（12.3%）受试者死亡。年龄和性别调整后的全因死亡率危险比（HR）分别为：已知糖尿病为 2.6（95%CI，1.7-3.8），未诊断的糖尿病为 2.8（95%CI，1.7-4.4），糖尿病前期为 1.1（95%CI，0.8-1.7）[参考：正常血糖耐量（NGT）]。经过多变量调整后，与 NGT 相比，未诊断的糖尿病与癌症死亡率增加 3.0 倍、心血管死亡率增加 1.1 倍、非癌症非心血管死亡率增加 4.7 倍相关。对于 HbA1c、FPG 和 2hPG，观察到与全因死亡率呈 J 形关联。在这个老年人群中，未诊断的糖尿病与全因、癌症和非癌症非心血管死亡率增加相关，但与心血管死亡率无关。未诊断的糖尿病的全因死亡率与已知的糖尿病相似，但远高于糖尿病前期和 NGT 的死亡率。
