The purpose of this study was to investigate the association of glycemia with cause-specific mortality in a diabetic population.
The study was a cohort design based in a primary care setting. Participants were all younger-onset diabetic persons (conditions diagnosed when they were younger than 30 years old and taking insulin, N=1210) and a random sample of older-onset diabetic persons (conditions diagnosed when they were 30 years or older, N=1780). Glycosylated hemoglobin levels were obtained at baseline examinations in 1980 to 1982 in which 996 younger-onset and 1370 older-onset persons participated. Median follow-up was 10 years in younger-onset and 8.3 years in older-onset persons; four younger-onset and two older-onset persons were unavailable for follow-up. The main outcome measure was cause-specific mortality as determined from death certificates.
In the younger-onset group after controlling for other risk factors in proportional hazards models and considering underlying cause of death, glycosylated hemoglobin was significantly associated with mortality from diabetes (hazard ratio [HR] for a 1% change in glycosylated hemoglobin, 1.25; 95% confidence interval [CI], 1.13 to 1.38) and ischemic heart disease (HR, 1.18; 95% CI, 1.00 to 1.40). In the older-onset group, glycosylated hemoglobin was significantly associated with mortality from diabetes (HR, 1.32; 95% CI, 1.21 to 1.43), ischemic heart disease (HR, 1.10; 95% CI, 1.04 to 1.17), and stroke (HR, 1.17; 95% CI, 1.05 to 1.30), but not cancer (HR, 0.99; 95% CI, 0.88 to 1.10). Results for any mention of specific causes of death were similar.
These results suggest possible benefit to the control of glycemia with respect to death due to vascular disease and diabetes.(Arch Intern Med. 1994;154:2473-2479)