Postchallenge Hyperglycemia and Mortality in a National Sample of U.S. Adults
- Sharon H. Saydah, MHS1,
- Montserrat Miret, MD, MPH2,
- Jennifer Sung, PHARMD, MS3,
- Cristina Varas, MD, MS2,
- Douglas Gause, DRPH, MPH3 and
- Frederick L. Brancati, MD, MHS1
- 1Johns Hopkins Medical Institutions, Baltimore, Maryland
- 2Global Epidemiology, CS&-E, Novartis Farmacéutica, Barcelona, Spain
- 3Health Care Management, Novartis Pharmaceuticals, East Hanover, New Jersey
OBJECTIVE—Although postchallenge hyperglycemia is a well-established feature of type 2 diabetes, its association with risk of mortality is uncertain. Therefore, the aim of this study was to assess the independent association of fasting and 2-h glucose levels with all-cause and cardiovascular disease (CVD) mortality.
RESEARCH DESIGN AND METHODS—We analyzed data from the Second National Health and Nutrition Examination Survey (NHANES II) Mortality Study, a prospective cohort study of U.S. adults examined in the NHANES II, and focused on the 3,092 adults aged 30–74 years who underwent an oral glucose tolerance test at baseline (1976–1980). Deaths were identified from U.S. national mortality files from 1976 to 1992. To account for the complex survey design, we used SUDAAN statistical software for weighted analysis.
RESULTS—Compared with their normoglycemic counterparts (fasting glucose [FG] <7.0 and 2-h glucose <7.8 mmol/l), adults with fasting and postchallenge hyperglycemia (FG ≥7.0 and 2-h glucose ≥11.1 mmol/l) had a twofold higher risk of death after 16 years of follow-up (age- and sex-adjusted relative hazard [RH] 2.1, 95% CI 1.4–3.2). However, adults with isolated postchallenge hyperglycemia (FG <7.0 and 2-h glucose ≥11.1 mmol/l) were also at higher risk of death (1.6, 1.0–2.6). In proportional hazards analysis, FG (fully adjusted RH 1.10 per 1 SD; 95% CI 1.01, 1.22) and 2-h glucose (1.14, 1.00–1.29) showed nearly identical predictive value for mortality. Similar trends were observed for CVD mortality.
CONCLUSIONS—These results suggest that postchallenge hyperglycemia is associated with increased risk of all-cause and CVD mortality independently of other CVD risk factors.
- ADA, American Diabetes Association
- CVD, cardiovascular disease
- FG, fasting glucose
- IGT, impaired glucose tolerance
- NHANES II, Second National Health and Nutrition Examination Survey
- OGTT, oral glucose tolerance test
- PCH, postchallenge hyperglycemia
- RH, relative hazard
- WHO, World Health Organization
Address correspondence and reprint requests to Dr. Brancati, Welch Center for Prevention, Epidemiology, and Clinical Research, the Johns Hopkins Medical Institutions, 2024 East Monument St., Suite 2-600, Baltimore, MD 21205. E-mail:.
Received for publication 13 December 2000 and accepted in revised form 3 May 2001.
S.H.S. and F.L.B. received consulting fees from Novartis Pharmaceuticals.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.