title: Extreme values of hemoglobin a1c are associated with increased risks of chronic obstructive pulmonary disease in patients with type 2 diabetes: a competing risk analysis in national cohort of Taiwan diabetes study.
abstract: The purpose of this study was to evaluate the relationship between glycated hemoglobin (HbA1c) and chronic obstructive pulmonary disease (COPD) in patients with type 2 diabetes.We conducted a retrospective cohort study involving 45,753 patients with type 2 diabetes, who participated in the National Diabetes Case Management Program in Taiwan. HbA1c at baseline and COPD events over the subsequent years were analyzed.After multivariate adjustment, the COPD risk increased among patients with HbA1c levels <6.0%, compared with that in patients with HbA1c levels ranging from 6.0% to 7.0% (hazard ratio: 1.19, 95% confidence interval (CI): 1.06-1.34). Similarly, high HbA1c levels (≥10%) were independently associated with COPD (1.19, 95% CI: 1.06-1.32). A U-shaped relationship was observed between HbA1c levels and COPD incidence.HbA1c levels lower than 6.0% and higher than 10% are associated with an increased risk of COPD in patients with type 2 diabetes. These findings suggest that meeting the recommended HbA1c targets might reduce the risk of COPD, but care should be taken not to pose risks to this population.
authors.affiliation: From the Department of Medical Research (C-IL, C-SL, C-CL), China Medical University Hospital; School of Medicine (C-IL, C-SL, W-YL, C-CL), College of Medicine; Graduate Institute of Biostatistics (T-CL, S-YY), College of Management, China Medical University; Department of Healthcare Administration (T-CL), College of Health Science, Asia University; Department of Family Medicine (C-SL, C-CL, W-YL); Division of Endocrinology and Metabolism (C-CC), Department of Medicine, China Medical University Hospital; and School of Chinese Medicine (C-CC), College of Chinese Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chia-Ing
authors.initials: CI
authors.lastname: Li
authors.forename: Tsai-Chung
authors.initials: TC
authors.lastname: Li
authors.forename: Chiu-Shong
authors.initials: CS
authors.lastname: Liu
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Lin
authors.forename: Ching-Chu
authors.initials: CC
authors.lastname: Chen
authors.forename: Sing-Yu
authors.initials: SY
authors.lastname: Yang
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Lin
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human