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Glycaemic measures and risk of mortality in older Chinese: the Guangzhou Biobank Cohort Study.

CONTEXT
China has the largest number of people with type 2 diabetes mellitus (T2DM) in the world. Data from previous studies suggested that up to one-fifth of individuals with diabetes would be missed without an oral glucose tolerance test (OGTT). To date there is little information on the mortality risk of these individuals.


OBJECTIVE
We estimated the association of different indicators of hyperglycaemia with mortality in the general Chinese population.


DESIGN
Prospective cohort study.


SETTING
China.


PARTICIPANTS
17,939 participants aged 50+ years.


EXPOSURES
Previously diagnosed diabetes and newly detected diabetes defined by fasting glucose (≥7.0 mmol/L), 2h post-load glucose (≥11.1 mmol/L), or haemoglobin A1c (HbA1c, ≥6.5%).


MAIN OUTCOMES MEASURES
Deaths from all-cause, cardiovascular disease and cancer were identified by record linkage with death registration.


RESULTS
During 7.8 (standard deviation=1.5) years' follow-up, 1,439 deaths were recorded. Of 3,706 participants with T2DM, 2126 (57%) had known T2DM, 118 (3%) were identified by isolated elevated fasting glucose, 1022 (28%) had isolated elevated post-load glucose, and 440 (12%) had both elevated fasting and post-load glucose. Compared to normoglycaemia, the HR (95% CI) of all-cause mortality was 1.71 (1.46, 2.00), 0.96 (0.47, 1.93), 1.43 (1.15-1.78) and 1.82 (1.35-2.45) for the four groups above, respectively. T2DM defined by elevated HbA1c was not significantly associated with all-cause mortality (HR 1.17, 95% 0.81-1.69).


CONCLUSION
Individuals with isolated higher 2h post-load glucose had a higher risk of mortality by 43% than those with normoglycaemia. Under-use of OGTT leads to substantial under-detection of individuals with a higher mortality risk and lost opportunities for early intervention.