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Epidemiology/Health Services/Psychosocial Research

Postchallenge Hyperglycemia and Mortality in a National Sample of U.S. Adults

  1. Sharon H. Saydah, MHS1,
  2. Montserrat Miret, MD, MPH2,
  3. Jennifer Sung, PHARMD, MS3,
  4. Cristina Varas, MD, MS2,
  5. Douglas Gause, DRPH, MPH3 and
  6. Frederick L. Brancati, MD, MHS1
  1. 1Johns Hopkins Medical Institutions, Baltimore, Maryland
  2. 2Global Epidemiology, CS&-E, Novartis Farmacéutica, Barcelona, Spain
  3. 3Health Care Management, Novartis Pharmaceuticals, East Hanover, New Jersey
    Diabetes Care 2001 Aug; 24(8): 1397-1402. https://doi.org/10.2337/diacare.24.8.1397
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    Article Figures & Tables

    Tables

    • Table 1—

      Baseline characteristics of 3,092 NHANES II participants aged 30 to 74 years by 2-h postchallenge glucose level

      2-h glucose <11.1 mmol/l (n = 2,856)2-h glucose ≥11.1 mmol/l (n = 236)
      Age (years)*48.8 ± 0.3058.2 ± 1.03
      Female (%)53.958.7
      White (%)89.584.5
      Education less than high school (%)*34.552.9
      Ever smoker (%)61.757.6
      Physical activity (i.e., low to moderate)25.232.8
      Systolic blood pressure (mmHg)*127.3 ± 0.83143.7 ± 1.96
      Diastolic blood pressure (mmHg)*79.1 ± 0.5384.3 ± 0.81
      BMI kg/m2 (%)*
       <2549.924.4
       25 ≤ to <2717.614.6
       27 ≤ to <3017.619.6
       ≥3014.941.4
      Total cholesterol–to–HDL cholesterol ratio4.7 ± 0.065.4 ± 0.18
      Fasting plasma glucose (mmol/l)*5.1 ± 0.027.7 ± 0.23
      History of CVD (%)*8.620.4
      Diagnosed diabetes (%)*1.519.7
      • Data are means ± SD or %.

      • *

        ↵* P < 0.05 for comparison of those with 2-h glucose <11.1 mmol/l vs. 2-h glucose ≥11.1 mmol/l.

    • Table 2—

      All-cause and cardiovascular disease mortality by fasting and 2-h postchallenge glucose group for 3,092 adults aged 30 to 74 years in NHANES II

      Fasting plasma glucose <7.0 mmol/l
      Fasting plasma glucose ≥7.0 mmol/l
      2-h plasma glucose (mmol/l)
      2-h plasma glucose (mmol/l)
      <7.87.8 to 11.1≥11.1<7.87.8 to 11.1≥11.1
      Participants2,321503131923105
      Person years31,8776,5331,6041252411,230
      Deaths4161374721148
      CVD deaths18159230827
      All-cause
       Mortality per 1,000 PY13.121.029.316.045.639.0
       RH (95% CI)*1.0 Reference1.3 (1.0, 1.6)1.6 (1.0, 2.6)——2.1 (1.4, 3.2)
       RH (95% CI)†1.0 Reference1.1 (0.8, 1.6)1.3 (0.7, 2.5)——1.9 (1.1, 3.2)
      CVD death
       Mortality per 1,000 PY5.79.014.3033.222.0
       RH (95% CI)*1.0 Reference1.1 (0.7, 1.5)1.4 (0.8, 2.5)——2.3 (1.4, 3.6)
       RH (95% CI)†1.0 Reference1.0 (0.6, 1.6)1.3 (0.6, 2.8)——1.6 (0.8, 3.4)
      • Data are n unless otherwise stated. — Too few events for stable estimate.

      • *

        ↵* RH and 95% CI adjusted for age (continuous) and sex;

      • †

        ↵† adjusted for age (continuous), sex, race (white, nonwhite), education (<high school, ≥high school), smoking (ever, never), physical activity (low, high), BMI (<25, 25≤ to <27, 27≤ to <30, ≥30 kg/m2), systolic blood pressure, and total cholesterol–to–HDL cholesterol ratio (continuous). PY, person years.

    • Table 3—

      RH and 95% CI for all-cause and CVD mortality for 1 SD increment in plasma glucose for 3,092 adults aged 30–74 years in NHANES II

      All-cause mortality
      CVD Mortality
      Fasting glucose2-h glucoseFasting glucose2-h glucose
      Model 1
       RH*1.101.141.091.13
       95% CI1.00–1.221.00–1.290.95–1.250.93–1.38
       P value β0.020.030.560.61
      Model 2
       RH*1.051.101.021.07
       95% CI0.89–1.230.91–1.330.79–1.320.78–1.46
       P value β0.370.590.850.67
      • Model 1, proportional hazards model adjusts for either fasting or 2-h glucose; model 2, proportional hazards model adjusts for fasting and 2-h glucose simultaneously. SD for fasting glucose 1.18 mmol/l and for 2-h glucose 3.18 mmol/l.

      • *

        ↵* Adjusted for age (continuous), sex, race (white, nonwhite), education (<high school, ≥high school), smoking (ever, never), physical activity (low, high), BMI (<25, 25≤ to <27, 27≤ to <30, ≥30 kg/m2), systolic blood pressure, total cholesterol–to–HDL cholesterol ratio (continuous).

    • Table 4—

      RH (95% CI) for all-cause and CVD mortality by 1997 ADA and 1998 WHO criteria for 3,092 adults aged 30–74 years in NHANES II

      Normal glucose toleranceImpaired fasting glucoseUndiagnosed diabetesDiagnosed diabetes
      ADA
       n2,7061939796
       All-cause
        RH (95% CI)Reference1.08 (0.70–1.67)1.41 (0.77–2.58)1.86 (1.03–3.15)
       CVD
        RH (95% CI)Reference0.65 (0.31–1.34)1.23 (0.49–3.07)1.70 (1.02–2.84)
      WHO
       n2,22655521596
       All-cause
        RH (95% CI)Reference1.14 (0.80–1.63)1.36 (0.84–2.21)1.89 (1.07–3.36)
       CVD
        RH (95% CI)Reference0.93 (0.57–1.51)1.21 (0.62–2.39)1.76 (1.03–3.01)
      • Participants with impaired fasting glucose (defined as 2-h glucose <7.8 mmol/l and fasting glucose ≥6.1 and <7.0 mmol/l) (n = 76) were excluded from the analysis because of small numbers. There were 26 deaths among these participants.

      • *

        * Adjusted for age (continuous), sex, race (white, non-white), education (<high school, ≥high school), smoking (ever, never), physical activity (low, high), BMI (<25, 25≤ to <27, 27≤ to <30, ≥30 kg/m2), systolic blood pressure, total cholesterol–to–HDL cholesterol ratio (continuous).

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    Postchallenge Hyperglycemia and Mortality in a National Sample of U.S. Adults
    Sharon H. Saydah, Montserrat Miret, Jennifer Sung, Cristina Varas, Douglas Gause, Frederick L. Brancati
    Diabetes Care Aug 2001, 24 (8) 1397-1402; DOI: 10.2337/diacare.24.8.1397

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    Postchallenge Hyperglycemia and Mortality in a National Sample of U.S. Adults
    Sharon H. Saydah, Montserrat Miret, Jennifer Sung, Cristina Varas, Douglas Gause, Frederick L. Brancati
    Diabetes Care Aug 2001, 24 (8) 1397-1402; DOI: 10.2337/diacare.24.8.1397
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