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

Abstract

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.

Gender difference in all-cause and cardiovascular mortality related to hyperglycaemia and newly-diagnosed diabetes

“…Diabetes is associated with increased mortality, especially from CVD [5,6]. Hyperglycaemia, in the absence of clinically diagnosed diabetes, is also associated with an increased CVD risk [7,8,9,10,11,12,13,14]. Several studies indicated a greater relative risk of CVD with diabetes [4,14] and hyperglycaemia [7,11,15] among women than men, while the Hoorn Study reported no consistent differences [9].…”

Efficacy and Adverse Effects of Nateglinide in Early Type 2 Diabetes. Comparison with Voglibose in a Cross-over Study

“…Recent studies indicated that fasting glucose concentrations alone do not identify individuals at increased risk of death associated with hyperglycemia and that mealtime glycemia significantly contributes to overall glycemic control and coronary artery disease mortality [9][10][11]. In this regard, even subjects with impaired glucose tolerance are also at risk of death similar to type 2 diabetes patients.…”

“…Postprandial hyperglycemia observed in impaired glucose tolerance may be a prospective determinant of cardiovascular disease [9][10][11] and the efficacy of intervention to treat this abnormality has been reported or is currently under investigation [12,13]. The above background suggests that we have to treat patients with early type 2 diabetes more intensively and to continue to search for effective and acceptable oral hyperglycemic agents for early type 2 diabetes.…”

Anti-Hyperglycemic Potency of Jatropha Gossypiifolia in Alloxan Induced Diabetes

“…At the end of the treatment period, rats in each group were starved overnight but had access to water ad libitum, weighed and sacrificed by cervical dislocation while under anesthesia, 2 ml blood was collected from each rat by cardiac puncture into plain tube [7,8]. The blood was allowed to stand for 5 minutes and then centrifuged at 3500 rpm (Beckman GS-6R, Germany) for 10 minutes at 4°C.…”