The HbA1c and all-cause mortality relationship in patients with type 2 diabetes is J-shaped: a meta-analysis of observational studies.
The HbA1c and all-cause mortality relationship in patients with type 2 diabetes is J-shaped: a meta-analysis of observational studies.
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DOI：
10.1900/rds.2014.11.138
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发表时间：
2014-01-01
期刊：
影响因子：
--
通讯作者：
Wang, Zhiqiang
中科院分区：
文献类型：
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作者：
Arnold, Luke W;Wang, Zhiqiang
背景：糖尿病管理文献中推荐低血糖和HbA 1c水平。然而，数据显示，低血糖与患者的严重不良反应有关，该建议受到了批评。因此，本文通过对观察性研究的荟萃分析，重新审视HbA 1c与全因死亡率之间的关系。目的：本研究的目的是确定HbA 1c与2型糖尿病患者的全因死亡率之间是否存在J形或U形非线性关系，这意味着HbA 1c在高和低水平时过早全因死亡的风险增加。使用PubMed、Medline和科克伦图书馆数据库进行了全面的文献检索，纳入/排除标准严格。分析了已发表的每种HbA 1c类别和每项研究的全因死亡率的校正风险比（HR）及其95%置信区间。使用分数多项式回归和随机效应建模来评估研究之间HR趋势的非线性关系。七个合格的观察性研究，共147，424名参与者被纳入了研究中。结果：观察到HbA 1c和全因死亡率之间存在显著的J形关系。全因死亡的粗相对风险确定为HbA 1c低于7.5%（58 mmol/mol）每增加1%风险降低（0.90，CI 0.86-0.94），HbA 1c高于7.5%（58 mmol/mol）每增加1%风险增加（1.04，CI 1.01-1.06）。观察性研究揭示了一个J形的关系HbA 1c和全因死亡率，相当于在高和低HbA 1c level.CONCLUSIONS死亡率增加的风险：这种增加的死亡率在高和低HbA 1c水平调查最佳临床HbA 1c的目标有显着的影响，因为它表明，有上限和下限为创建一个“安全区”糖尿病管理。
BACKGROUND: Low blood glucose and HbA1c levels are recommended in the literature on management of diabetes. However, data have shown that low blood glucose is associated with serious adverse effects for the patients and the recommendation has been criticized. Therefore, this article revisits the relationship between HbA1c and all-cause mortality by a meta-analysis of observational studies.AIM: The aim of this study is to determine whether there is a J- or U-shaped non-linear relationship between HbA1c and all-cause mortality in type 2 diabetes patients, implying an increased risk to premature all-cause mortality at high and low levels of HbA1c.METHODS: A comprehensive literature search was conducted using PubMed, Medline, and Cochrane Library databases with strict inclusion/exclusion criteria. The published adjusted hazard ratios (HR) with 95% confidence intervals of all-cause mortality for each HbA1c category and per study were analyzed. Fractional polynomial regression was used with random effect modeling to assess the non-linear relationship of the HR trends between studies. Seven eligible observational studies with a total of 147,424 participants were included in the study.RESULTS: A significant J-shaped relationship was observed between HbA1c and all-cause mortality. Crude relative risk for all-cause mortality identified a decreased risk per 1% increase in HbA1c below 7.5% (58 mmol/mol) (0.90, CI 0.86-0.94) and an increased risk per 1% increase in HbA1c above 7.5% (58 mmol/mol) (1.04, CI 1.01-1.06). Observational studies revealed a J-shaped relationship between HbA1c and all-cause mortality, equivalent to an increased risk of mortality at high and low HbA1c levels.CONCLUSIONS: This increased mortality at high and low HbA1c levels has significant implications on investigating optimum clinical HbA1c targets as it suggests that there are upper and lower limits for creating a 'security zone' for diabetes management.