title: All-cause mortality and pharmacological treatment intensity following a high risk screening program for diabetes. A 6.6 year follow-up of the ADDITION study, Denmark.
abstract: OBJECTIVE
  To study all-cause mortality and pharmacological treatment intensity in relation to baseline glucose metabolism and HbA1c following high risk screening for diabetes in primary care.
  
  
  METHODS
  Persons aged 40-69 years (N=163,185) received mailed diabetes risk questionnaires. 20,916 persons without diabetes but with high risk of diabetes were stratified by glucose metabolism (normal glucose tolerance (NGT), dysglycemia (IFG or IGT) or diabetes) and by HbA1c at screening (<6%, 6.0-6.4% or ≥ 6.5%). Median follow-up was 6.6 years. Excess mortality was calculated by hazard ratio.
  
  
  RESULTS
  HR for all-cause mortality increased with increasing levels of HbA1c at screening in people with NGT and dysglycemia. In people with screen detected diabetes the opposite relation was found. In people with diabetes redeemed prescription rates for lipid-, blood pressure- and glucose-lowering drugs increased significantly following screening and prescription rates increased with increasing levels of HbA1c at screening. The same trend in redeemed prescriptions was seen for people with dysglycemia and NGT, but the absolute rates were significantly lower than those among people with screen detected diabetes.
  
  
  CONCLUSIONS
  This study confirms HbA1c as an independent predictor of all-cause mortality in non-diabetic individuals. A likely explanation for the inverse relation found between all-cause mortality and HbA1c at screening among those with screen detected diabetes would be that intensive treatment near-normalizes mortality. The small group of people with NGT and HbA1c ≥ 6.5%, who had the highest all-cause mortality, may benefit from being labelled and treated as having diabetes although this group may have special characteristics not accounted for in this study.
authors.affiliation: School of Public Health, Department of General Practice, University of Aarhus, Denmark. tl@alm.au.dk
authors.forename: Torsten
authors.initials: T
authors.lastname: Lauritzen
authors.forename: Annelli
authors.initials: A
authors.lastname: Sandbaek
authors.forename: Anders Helles
authors.initials: AH
authors.lastname: Carlsen
authors.forename: Knut
authors.initials: K
authors.lastname: Borch-Johnsen
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D016009:Chi-Square Distribution; D015897:Comorbidity; D003718:Denmark; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality*; D050171:Dyslipidemias / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; C517652:hemoglobin A1c protein, human