TY - JOUR
T1 - Predictive value of fasting glucose, postload glucose, and hemoglobin A1c on risk of diabetes and complications in Chinese adults
AU - 4C Study Group
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
N1 - Funding Information:
Acknowledgments. The authors thank all study participants. Funding. The research reported in this publication was supported by the National Basic ResearchProgramofChina(973Program)(award no. 2015CB553601); the Ministry of Science and Technology of the People’s Republic of China (awardnos.2016YFC1305600,2016YFC1305202, 2016YFC0901200, 2016YFC1304904, 2017YFC1310700, and 2018YFC1311800); and the National Natural Science Foundation of China (award nos. 81700764, 81670795, 81621061, and 81561128019). Duality of Interest. No potential conflicts of interest relevant to this article were reported.
Funding Information:
1Shanghai 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 2Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 3The First Hospital of Lanzhou University, Lanzhou, China 4Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China 5Affiliated Hospital of Guiyang Medical College, Guiyang, China 6Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China 7Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 8Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China 9The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China 10The Affiliated Hospital of Southwest Medical University, Luzhou, China 11Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China 12Dalian Municipal Central Hospital, Dalian, China 13The First Hospital of Jilin University, Chang-chun, China
Funding Information:
The research reported in this publication was supported by the National Basic Research Program of China (973 Program) (award no. 2015CB553601); the Ministry of Science and Technology of the People's Republic of China (award nos. 2016YFC1305600, 2016YFC1305202, 2016YFC0901200, 2016YFC1304904, 2017YFC1310700, and 2018YFC1311800); and the National Natural Science Foundation of China (award nos. 81700764, 81670795, 81621061, and 81561128019). Duality of Interest. No potential conflicts of interest relevant to this article were reported.
Publisher Copyright:
© 2019 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.
PY - 2019/8/1
Y1 - 2019/8/1
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.
AB - 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.
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U2 - 10.2337/dc18-1390
DO - 10.2337/dc18-1390
M3 - Article
C2 - 31152120
AN - SCOPUS:85070069391
SN - 0149-5992
VL - 42
SP - 1539
EP - 1548
JO - Diabetes care
JF - Diabetes care
IS - 8
ER -