title: Baseline glycemic status and mortality in 241,499 Korean metropolitan subjects: A Kangbuk Samsung Health Study.
abstract: OBJECTIVE
  Diabetes and prediabetes subjects have increased risk for mortality. We analyzed the mortality risk due to all causes, cardiovascular disease (CVD) and cancer in Korean subjects participating in a health-screening program according to baseline glycemic status and HbA1c levels.
  
  
  METHODS
  Among 241,499 participants of a health-screening program between 2005 and 2012, the risk of death from all causes, CVD, and cancer was calculated based on the baseline glycemic status (normoglycemia, prediabetes, and diabetes) and HbA1c levels. Uncontrolled diabetes was defined as HbA1c≥7.0%. Vital status and confirmation of the cause of death were based on the analysis of death certificate records from the National Death Index.
  
  
  RESULTS
  During 923,343.1 person-years of follow-up, 877 participants died. The multivariable-adjusted hazard ratios (HR) of subjects with controlled and uncontrolled diabetes to normoglycemic subjects for all-cause mortality were 1.58 (95% CI 1.24-2.03) and 2.26 (95% CI 1.78-2.86), respectively. The HRs of subjects with controlled and uncontrolled diabetes to normoglycemic subjects for mortality due to cancer were 1.75 (95% CI 1.23-2.48) and 1.67 (95% CI 1.13-2.45). However, glycemic status was not significantly associated with the risk of mortality due to CVD. The subjects with HbA1c higher than 6.5% showed more than 2-fold increased risk for all-cause mortality and the subjects with HbA1c lower than 5.2% showed increased HR (1.45, 95% CI 1.06-1.97) compared with those with HbA1c of 5.5% in subjects not taking anti-diabetic medications.
  
  
  CONCLUSIONS
  Mortality risk from all causes and cancer significantly increased in diabetes subjects regardless of the glucose control status. In subjects not taking anti-diabetic medications, both high and low HbA1c resulted in increased risk for all-cause mortality.
authors.affiliation: Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Eun-Jung
authors.initials: EJ
authors.lastname: Rhee
authors.affiliation: Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Se Eun
authors.initials: SE
authors.lastname: Park
authors.affiliation: Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Yoosoo
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: sh703.yoo@samsung.com.
authors.forename: Seungho
authors.initials: S
authors.lastname: Ryu
authors.affiliation: Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: drlwy@hanmail.net.
authors.forename: Won-Young
authors.initials: WY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000401:mortality; D003920:Diabetes Mellitus / Q000097:blood* / Q000401:mortality*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Cancer; Diabetes; Glycemia; Mortality