Table 3

Cox proportional hazards models for all-cause mortality and CVD incidence and mortality in participants with diabetes by grip strength category

Age- and sex-specific grip strength category, HR (95% CI)P value
Total, nDeaths/events, nHigherMiddleLowerTrendTrendInteraction
All-cause mortality
 Model 0
  Without diabetes333,7575,6401.00 (Ref)1.22 (1.15, 1.29)1.69 (1.57, 1.81)1.29 (1.25, 1.34)<0.00010.009
  With diabetes13,3735691.00 (Ref)1.29 (1.05, 1.59)2.04 (1.65, 2.53)1.44 (1.29, 1.60)<0.0001
 Model 1
  Without diabetes333,7575,6401.00 (Ref)1.23 (1.16, 1.30)1.70 (1.59, 1.83)1.30 (1.25, 1.34)<0.00010.010
  With diabetes13,3735691.00 (Ref)1.32 (1.07, 1.62)2.10 (1.70, 2.61)1.46 (1.31, 1.63)<0.0001
 Model 2
  Without diabetes333,7575,6401.00 (Ref)1.23 (1.16, 1.30)1.70 (1.58, 1.82)1.30 (1.25, 1.34)<0.00010.020
  With diabetes13,3735691.00 (Ref)1.34 (1.09, 1.66)2.05 (1.65, 2.54)1.44 (1.29, 1.60)<0.0001
CVD mortality
 Model 0
  Without diabetes333,7575191.00 (Ref)1.27 (1.04, 1.55)1.71 (1.36, 2.16)1.30 (1.16, 1.47)<0.00010.019
  With diabetes13,373751.00 (Ref)1.52 (0.82, 2.81)2.62 (1.42, 4.81)1.63 (1.20, 2.21)0.002
 Model 1
  Without diabetes333,7575191.00 (Ref)1.30 (1.07, 1.58)1.78 (1.41, 2.25)1.33 (1.18, 1.49)<0.00010.017
  With diabetes13,373751.00 (Ref)1.61 (0.87, 2.99)2.83 (1.53, 5.21)1.69 (1.25, 2.29)0.001
 Model 2
  Without diabetes333,7575191.00 (Ref)1.30 (1.07, 1.59)1.78 (1.40, 2.25)1.33 (1.18, 1.49)<0.00010.016
  With diabetes13,373751.00 (Ref)1.69 (0.91, 3.13)2.88 (1.55, 5.35)1.70 (1.25, 2.30)0.001
CVD incidence
 Model 0
  Without diabetes333,7573,9661.00 (Ref)1.20 (1.12, 1.29)1.45 (1.33, 1.58)1.20 (1.15, 1.26)<0.00010.042
  With diabetes13,3733351.00 (Ref)1.08 (0.82, 1.42)1.87 (1.43, 2.46)1.39 (1.20, 1.60)<0.0001
 Model 1
  Without diabetes333,7573,9661.00 (Ref)1.23 (1.15, 1.32)1.51 (1.39, 1.65)1.23 (1.18, 1.28)<0.00010.037
  With diabetes13,3733351.00 (Ref)1.12 (0.85, 1.47)1.98 (1.50, 2.59)1.42 (1.24, 1.64)<0.0001
 Model 2
  Without diabetes333,7573,9661.00 (Ref)1.23 (1.14, 1.32)1.49 (1.36, 1.62)1.22 (1.17, 1.27)<0.00010.041
  With diabetes13,3733351.00 (Ref)1.14 (0.87, 1.50)1.98 (1.50, 2.60)1.42 (1.23, 1.64)<0.0001
  • People in the highest category for grip strength were used as the reference (Ref) category. Participants who were diagnosed with diabetes before the age of 30 years were removed from the analysis. All analyses were performed as a landmark analysis, with follow-up commencing 2 years after recruitment and including participants who were event free at that time. In addition, participants with comorbidities at baseline (depression, COPD, chronic asthma, chronic liver disease, alcohol problems, substance abuse, eating disorders, schizophrenia, cognitive impairment, Parkinson disease, dementia, chronic pain syndrome, heart disease, inflammatory disease, arthrosis, arthritis, CVD, and cancer [n = 103,755]) were excluded from all analyses. Model 0 was adjusted for age, sex, ethnicity, deprivation index, professional qualifications, gross income, employment, and month of recruitment. Model 1 was adjusted for duration of diabetes, systolic blood pressure, baseline prevalence of hypertension, and history of recent medication for diabetes (insulin), hypertension, and cholesterol. Model 2 was adjusted for model 1 plus BMI category, smoking, TV viewing, PC screen time, category of sleep duration, physical activity, and dietary intake (alcohol, fruits and vegetables, red meat, processed meat, and oily fish).