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Predictive Value of Fasting Glucose, Postload Glucose, and Hemoglobin A1c on Risk of Diabetes and Complications in Chinese Adults.
Diabetes Care. 2019 08; 42(8):1539-1548.DC

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.

Authors+Show Affiliations

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.Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA.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.The First Hospital of Lanzhou University, Lanzhou, China.Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.Affiliated Hospital of Guiyang Medical College, Guiyang, China.Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.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.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.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.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.Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.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.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.The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.The Affiliated Hospital of Southwest Medical University, Luzhou, China.Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.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.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.Dalian Municipal Central Hospital, Dalian, China.The First Hospital of Jilin University, Changchun, China.The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.The First Affiliated Hospital of Guangxi Medical University, Nanning, China.The First Affiliated Hospital of Guangxi Medical University, Nanning, China.Qilu Hospital of Shandong University, Jinan, China.Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China.The Second Affiliated Hospital of Harbin Medical University, Harbin, China.Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.Central Hospital of Shanghai Jiading District, Shanghai, China.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.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.Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China.The First Affiliated Hospital of Anhui Medical University, Hefei, China.Karamay Municipal People's Hospital, Xinjiang, China.The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.Johns Hopkins University School of Medicine, Baltimore, MD.Icahn School of Medicine at Mount Sinai, New York, NY.Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China byf10784@rjh.com.cn wqingw61@163.com gning@sibs.ac.cn muyiming@301hospital.com.cn jjzhao@medmail.com.cn cheria_chen@126.com.Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China byf10784@rjh.com.cn wqingw61@163.com gning@sibs.ac.cn muyiming@301hospital.com.cn jjzhao@medmail.com.cn cheria_chen@126.com.Chinese People's Liberation Army General Hospital, Beijing, China byf10784@rjh.com.cn wqingw61@163.com gning@sibs.ac.cn muyiming@301hospital.com.cn jjzhao@medmail.com.cn cheria_chen@126.com.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 byf10784@rjh.com.cn wqingw61@163.com gning@sibs.ac.cn muyiming@301hospital.com.cn jjzhao@medmail.com.cn cheria_chen@126.com.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 byf10784@rjh.com.cn wqingw61@163.com gning@sibs.ac.cn muyiming@301hospital.com.cn jjzhao@medmail.com.cn cheria_chen@126.com.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31152120

Citation

Lu, Jieli, et al. "Predictive Value of Fasting Glucose, Postload Glucose, and Hemoglobin A1c On Risk of Diabetes and Complications in Chinese Adults." Diabetes Care, vol. 42, no. 8, 2019, pp. 1539-1548.
Lu J, He J, Li M, et al. Predictive Value of Fasting Glucose, Postload Glucose, and Hemoglobin A1c on Risk of Diabetes and Complications in Chinese Adults. Diabetes Care. 2019;42(8):1539-1548.
Lu, J., He, J., Li, M., Tang, X., Hu, R., Shi, L., Su, Q., Peng, K., Xu, M., Xu, Y., Chen, Y., Yu, X., Yan, L., Wang, T., Zhao, Z., Qin, G., Wan, Q., Chen, G., Dai, M., ... Bi, Y. (2019). Predictive Value of Fasting Glucose, Postload Glucose, and Hemoglobin A1c on Risk of Diabetes and Complications in Chinese Adults. Diabetes Care, 42(8), 1539-1548. https://doi.org/10.2337/dc18-1390
Lu J, et al. Predictive Value of Fasting Glucose, Postload Glucose, and Hemoglobin A1c On Risk of Diabetes and Complications in Chinese Adults. Diabetes Care. 2019;42(8):1539-1548. PubMed PMID: 31152120.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictive Value of Fasting Glucose, Postload Glucose, and Hemoglobin A1c on Risk of Diabetes and Complications in Chinese Adults. AU - Lu,Jieli, AU - He,Jiang, AU - Li,Mian, AU - Tang,Xulei, AU - Hu,Ruying, AU - Shi,Lixin, AU - Su,Qing, AU - Peng,Kui, AU - Xu,Min, AU - Xu,Yu, AU - Chen,Yuhong, AU - Yu,Xuefeng, AU - Yan,Li, AU - Wang,Tiange, AU - Zhao,Zhiyun, AU - Qin,Guijun, AU - Wan,Qin, AU - Chen,Gang, AU - Dai,Meng, AU - Zhang,Di, AU - Gao,Zhengnan, AU - Wang,Guixia, AU - Shen,Feixia, AU - Luo,Zuojie, AU - Qin,Yingfen, AU - Chen,Li, AU - Huo,Yanan, AU - Li,Qiang, AU - Ye,Zhen, AU - Zhang,Yinfei, AU - Du,Rui, AU - Cheng,Di, AU - Liu,Chao, AU - Wang,Youmin, AU - Wu,Shengli, AU - Yang,Tao, AU - Deng,Huacong, AU - Li,Donghui, AU - Lai,Shenghan, AU - Bloomgarden,Zachary T, AU - Chen,Lulu, AU - Zhao,Jiajun, AU - Mu,Yiming, AU - Ning,Guang, AU - Wang,Weiqing, AU - Bi,Yufang, AU - ,, Y1 - 2019/05/31/ PY - 2018/06/29/received PY - 2019/05/09/accepted PY - 2019/6/4/pubmed PY - 2020/4/22/medline PY - 2019/6/2/entrez SP - 1539 EP - 1548 JF - Diabetes care JO - Diabetes Care VL - 42 IS - 8 N2 - 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. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/31152120/Predictive_Value_of_Fasting_Glucose_Postload_Glucose_and_Hemoglobin_A1c_on_Risk_of_Diabetes_and_Complications_in_Chinese_Adults_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=31152120 DB - PRIME DP - Unbound Medicine ER -