Hemoglobin A1c,comorbid conditions and all-cause mortality in older patients with diabetes: A retrospective 9-year cohort study |
| |
| Affiliation: | 1. Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, United States;2. Department of Health Services, School of Public Health, University of Washington, 1959 NE Pacific Street, Box 357660, Seattle, WA 98195-7660, United States;1. Kaiser Permanente, 3650 Steve Reynolds Boulevard, Duluth, GA 30096, USA;2. Division of Endocrinology, Emory University School of Medicine, 101 Woodruff Circle, Suite 1303, Atlanta, GA 30322, USA;3. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard University, 330 Brookline Avenue, Boston, MA 02215, USA;4. Department of Medicine, Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, 1300 Morris Park Avenue Block, Room 114, Bronx, NY 10461, USA;5. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, 1300 Morris Park Avenue Block, Room 114, Bronx, NY 10461, USA;1. Lilly S.A., Alcobendas, Madrid, Spain;2. Hospital Universitario de Getafe, Getafe, Madrid, Spain;1. UNSW, School of Public Health & Community Medicine, Sydney, Australia;2. Isfahan University of Medical Sciences, Health Information Research Centre, Isfahan, Iran;3. UNSW, Centre for Primary Health Care & Equity, Sydney, Australia;4. UNSW, Asia-Pacific Ubiquitous Healthcare Research Centre, Sydney, Australia;5. General Practice Unit, South Western Sydney Local Health District;1. Department of Internal Medicine, St Luke''s Roosevelt Hospital Center – Mount Sinai Health System, 1000 Tenth Avenue, Suite 3A-02, New York, NY 10019, USA;2. Department of Rheumatology, Rush University Medical Center, The Orthopedic Building at Rush University Medical Center, 1611W. Harrison Street, Suite 510, Chicago, IL 60612, USA;3. Department of Pathology, St Luke''s Roosevelt Hospital Center – Mount Sinai Health System, 1111 Amsterdam Avenue, New York, NY 10025, USA;4. Department of Internal Medicine, SMS Medical College & Attached Hospitals, J.L.N. Marg, Jaipur 302004 Rajasthan India;5. Department of Nephrology, The Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1243, New York, NY 10029, USA |
| |
| Abstract: | AimsTo examine whether hemoglobin A1c levels and comorbid conditions are related to all-cause mortality in a cohort of patients with type 1 or 2 diabetes receiving continuous care for 9 years. In patients with comorbid congestive heart failure (CHF), we test for ‘reverse epidemiology,’ or whether greater HbA1c values are associated with lower risk of mortality.MethodsThe population for this longitudinal cohort study was 8820 Group Health enrollees in the Seattle area with type 1 or 2 diabetes in 1997 and enrolled continuously from 1997 to 2006. Comorbid conditions were hypertension, coronary artery disease, congestive heart failure, depression, and chronic pulmonary disease. Mistimed HbA1c scores were addressed by multiple imputation, and Cox proportional hazards models estimated associations controlling for other risk factors.ResultsAbout 30% of the enrollees died in 1998–2006. CHF had the strongest association with all-cause mortality. Compared to enrollees with HbA1c ≥ 7.1% (54 mmol/mol) and <7.5% (58 mmol/mol; 5th decile), enrollees with HbA1c < 6.4% (46 mmol/mol) had a significantly greater risk of death (HR range: 1.28–2.26). HbA1c > 7.5% had HR < 1.0 but were not significant. For enrollees with diabetes and CHF at baseline, HbA1c scores ≥ 8.7% (72 mmol/mol) had a significantly lower risk of death (HR range: 0.64–0.69).ConclusionsIn our patient population, HbA1c scores < 6.4% have significantly higher all-cause mortality. CHF is a major determinant of all-cause mortality. Adults with comorbid CHF and high HbA1c scores have lower all-cause mortality. |
| |
| Keywords: | Diabetes Comorbid conditions Glycated hemoglobin Reverse epidemiology Mortality Congestive heart failure |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
