EURODIAB: High, low HbA1c levels increased risk for all-cause mortality

Schoenaker DA. J Clin Endocrinol Metab. 2014;doi:10.1210/jc.2013-2824.

  • January 3, 2014

Both high and low HbA1c levels in patients with type 1 diabetes indicated an increased risk for all-cause mortality, according to data. These findings suggest that specific HbA1c targets may not be appropriate in this patient population.

“We recognize that HbA1c levels below 5.6% in individuals with type 1 diabetes may be related to anemia, renal insufficiency, infection, or other factors not available in our database,” researchers wrote.

Danielle A.J.M. Schoenaker, MSc, a PhD candidate at the School of Public Health at the University of Queensland in Brisbane, Australia, and colleagues conducted the clinic-based prospective cohort study of 2,764 European patients with type 1 diabetes (aged 15 to 60 years) enrolled in the EURODIAB Prospective Complications Study.

They examined the potential of nonlinear associations between HbA1c thresholds and all-cause mortality using multivariable restricted cubic spline regression (at HbA1c 5.6%, 7.1%, 8.1%, 9.5% and 11.8%) and five knots (additionally at HbA1c 7.1% and 9.5%), according to data.

Mortality data were collected approximately 7 years after baseline, researchers wrote.

Data indicate that HbA1c was tied to all-cause mortality in a nonlinear fashion after adjustments for age and sex, according to Schoenaker and colleagues.

Moreover, both low HbA1c (<5.6%; HR=1.31; 95% CI, 0.67-2.42) and high HbA1c (>11.8%; HR=1.86; 95% CI, 1.12-3.05) were associated with an increased risk for all-cause mortality compared with the reference (8.1%), according to data.

“Our results are relevant to the discussion about the risk of intensive glycemic control in diabetes patients,” researchers wrote.

Disclosure: The researchers report no relevant financial disclosures


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