title: All-cause mortality in patients with type 2 diabetes in association with achieved hemoglobin A(1c), systolic blood pressure, and low-density lipoprotein cholesterol levels.
abstract: BACKGROUND
  To identify the ranges of hemoglobin A(1c) (HbA1c), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) levels which are associated with the lowest all-cause mortality.
  
  
  METHODS
  A retrospective cohort of 12,643 type 2 diabetic patients (aged ≥18 years) were generated from 2002 to 2010, in Far-Eastern Memorial Hospital, New Taipei city, Taiwan. Patients were identified to include any outpatient diabetes diagnosis (ICD-9: 250), and drug prescriptions that included any oral hypoglycemic agents or insulin prescribed during the 6 months following their first outpatient visit for diabetes. HbA1c, SBP, and LDL-C levels were assessed by the mean value of all available data, from index date to death or censor date. Deaths were ascertained by matching patient records with the Taiwan National Register of Deaths.
  
  
  RESULTS
  Our results showed general U-shaped associations, where the lowest hazard ratios occurred at HbA1c 7.0-8.0%, SBP 130-140 mmHg, and LDL-C 100-130 mg/dL. The risk of mortality gradually increases if the patient's mean HbA1c, SBP, or LDL-C during the follow-up period was higher or lower than these ranges. In comparison to the whole population, the adjusted hazard ratio (95% CI) for patients with HbA1c 7.0-8.0%, SBP 130-140 mmHg, and LDL-C 100-130 mg/dL were 0.69 (0.62-0.77), 0.80 (0.72-0.90), and 0.68 (0.61-0.75), respectively.
  
  
  CONCLUSIONS
  In our type 2 diabetic cohort, the patients with HbA1c 7.0-8.0%, SBP 130-140 mmHg, or LDL-C 100-130 mg/dL had the lowest all-cause mortality. Additional research is needed to confirm these associations and to further investigate their detailed mechanisms.
authors.affiliation: Section of Endocrinology & Metabolism, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Hou-Hsien
authors.initials: HH
authors.lastname: Chiang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Fen-Yu
authors.initials: FY
authors.lastname: Tseng
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Wang
authors.affiliation: Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Chi-Ling
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Section of Endocrinology & Metabolism, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Ting-Ting
authors.initials: TT
authors.lastname: See
authors.affiliation: Section of Endocrinology & Metabolism, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Hua-Fen
authors.initials: HF
authors.lastname: Chen
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002423:Cause of Death; D008078:Cholesterol, LDL / Q000097:blood*; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D008297:Male; D008875:Middle Aged; D062486:Public Health Surveillance; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin