London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, United Kingdom.
PLoS One. 2013 Jul 5;8(7):e68008. doi: 10.1371/journal.pone.0068008. Print 2013.
This study aimed to evaluate mortality within 365 days of HbA1c values of <6.5% or >9.0% in participants with clinical type 2 diabetes mellitus. A matched nested case-control study was implemented, within a cohort of participants with type 2 diabetes from 2000 to 2008. Conditional logistic regression was used to model the odds ratio for mortality adjusting for comorbidity and drug utilisation. There were 97,450 participants with type 2 diabetes; 16,585 cases that died during follow up were matched to 16,585 controls. The most recent HbA1c value was <6.5% (48 mmol/mol) for 22.2% of cases and 24.2% of controls, the HbA1c was >9.0% for 9.0% of cases and 7.7% of controls. In a complete case analysis, the adjusted odds ratio (AOR) for mortality associated with most recent HbA1c <6.5% was 1.31 (95% confidence interval (CI): 1.21,1.42). After multiple imputation of missing HbA1c values the AOR was 1.20 (CI: 1.12,1.28). The complete case analysis gave an AOR for HbA1c >9.0% of 1.51 (CI: 1.33, 1.70), in the multiple imputation analysis this was 1.29 (1.17,1.41). The risk associated with HbA1c <6.5% was age dependent. In the multiple imputation analysis the AOR was 1.53 (CI: 0.84 to 2.79) at age<55 years but 1.04 (CI: 0.92, 1.17) at age 85 years and over. In non-randomised data, values of HbA1c that are either <6.5% or >9.0% may be associated with increased mortality within one year in clinical type 2 diabetes. Relative risks may be higher at younger ages.
本研究旨在评估临床 2 型糖尿病患者的糖化血红蛋白（HbA1c）值<6.5%或>9.0%时的 365 天内死亡率。在 2000 年至 2008 年间，对 2 型糖尿病患者进行了一项匹配嵌套病例对照研究。采用条件逻辑回归模型，在调整合并症和药物使用的情况下，对死亡率的比值比进行建模。共有 97450 名 2 型糖尿病患者；在随访期间，有 16585 例死亡病例与 16585 例对照病例相匹配。最近的 HbA1c 值<6.5%（48mmol/mol）的病例占 22.2%，对照病例占 24.2%，HbA1c 值>9.0%的病例占 9.0%，对照病例占 7.7%。在完整病例分析中，与最近的 HbA1c 值<6.5%相关的死亡率调整比值比（AOR）为 1.31（95%置信区间（CI）：1.21，1.42）。在缺失的 HbA1c 值进行多次插补后，AOR 为 1.20（CI：1.12，1.28）。完整病例分析得出的 HbA1c 值>9.0%的 AOR 为 1.51（CI：1.33，1.70），在多次插补分析中，这一数字为 1.29（1.17，1.41）。HbA1c 值<6.5%与年龄相关。在多次插补分析中，AOR 为 55 岁以下年龄组为 1.53（CI：0.84，2.79），85 岁及以上年龄组为 1.04（CI：0.92，1.17）。在非随机数据中，HbA1c 值<6.5%或>9.0%可能与临床 2 型糖尿病患者一年内的死亡率增加相关。相对风险在较年轻时可能更高。
