title: The association between glycated hemoglobin levels and mortality in non-diabetic elderly subjects.
abstract: BACKGROUND
  Glycated hemoglobin (HgbA1c) is extensively used as a screening tool for the diagnosis of diabetes mellitus (DM). Although its prognostic value among diabetics has been extensively studied, similar data among non-diabetics is scarce. The aim of this study was to evaluate the association between HgbA1c and mortality in non-diabetic elderly individuals.
  
  
  METHODS
  A review of a computerized database of a large health care organization was performed. Non-diabetic individuals≥65years old with HgbA1c levels<6.5% evaluated during the years 2002-2012 were included in the analysis. Subjects were stratified into quintiles based on HgbA1c levels. Hazard ratios (HR) for mortality were compared between the quintiles.
  
  
  RESULTS
  The cohort included 12,937 non-diabetic individuals≥65years who did not develop DM during the follow-up period. The lowest mortality rate was observed in the fourth HgbA1c quintile [HgbA1c 5.9-6.1% (41-43mmol/mol)]. Compared with the mortality rate in the fourth quintile, mortality rate was increased in the lowest (HgbA1c<5.39%, 35mmol/mol, HR 1.21 CI 1.09-1.35) and highest (HgbA1c>6.11%, 43mmol/mol, HR 1.17 CI 1.04-1.32) HgbA1c quintiles. This association persisted after adjustment for age, gender and co-morbidities.
  
  
  CONCLUSIONS
  The association between HgbA1c and all-cause mortality in non-diabetic elderly individuals has a U-shape form with the highest mortality in those with the lowest and highest HgbA1c levels.
authors.affiliation: Unit of Endocrinology and Metabolism, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel. Electronic address: along@clalit.org.il.
authors.forename: Alon
authors.initials: A
authors.lastname: Grossman
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Geriatrics, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Yichayahou
authors.initials: Y
authors.lastname: Beloosesky
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Geriatrics, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Agatha
authors.initials: A
authors.lastname: Schlesinger
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Internal Medicine A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Gafter-Gvili
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Nira
authors.initials: N
authors.lastname: Koren-Morag
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Chief Pediatrician, Community Division, Clalit Health Services, Tel Aviv, Israel; Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
authors.forename: Joseph
authors.initials: J
authors.lastname: Meyerovitch
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Geriatrics, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Avraham
authors.initials: A
authors.lastname: Weiss
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003920:Diabetes Mellitus; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007557:Israel; D008297:Male; D009026:Mortality; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Elderly; Glycated hemoglobin; Hemoglobin A1C; Mortality