Endocrinol Metab.  2023 Oct;38(5):525-537. 10.3803/EnM.2023.1765.

Risk of Cause-Specific Mortality across Glucose Spectrum in Elderly People: A Nationwide Population-Based Cohort Study

• Lee J
• Kim HS
• Song KH
• Yoo SJ
• Han K
• Lee SH
• Committee of Big Data, Korean Endocrine Society

• KMID: 2546983
• DOI: http://doi.org/10.3803/EnM.2023.1765

Abstract

Background
This study investigated the risk of cause-specific mortality according to glucose tolerance status in elderly South Koreans.
Methods
A total of 1,292,264 individuals aged ≥65 years who received health examinations in 2009 were identified from the National Health Information Database. Participants were classified as normal glucose tolerance, impaired fasting glucose, newly-diagnosed diabetes, early diabetes (oral hypoglycemic agents ≤2), or advanced diabetes (oral hypoglycemic agents ≥3 or insulin). The risk of system-specific and disease-specific deaths was estimated using multivariate Cox proportional hazards analysis.
Results
During a median follow-up of 8.41 years, 257,356 deaths were recorded. Diabetes was associated with significantly higher risk of all-cause mortality (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.57 to 1.60); death due to circulatory (HR, 1.49; 95% CI, 1.46 to 1.52), respiratory (HR, 1.51; 95% CI, 1.47 to 1.55), and genitourinary systems (HR, 2.22; 95% CI, 2.10 to 2.35); and neoplasms (HR, 1.30; 95% CI, 1.28 to 1.32). Diabetes was also associated with a significantly higher risk of death due to ischemic heart disease (HR, 1.70; 95% CI, 1.63 to 1.76), cerebrovascular disease (HR, 1.46; 95% CI, 1.41 to 1.50), pneumonia (HR, 1.69; 95% CI, 1.63 to 1.76), and acute or chronic kidney disease (HR, 2.23; 95% CI, 2.09 to 2.38). There was a stepwise increase in the risk of death across the glucose spectrum (P for trend <0.0001). Stroke, heart failure, or chronic kidney disease increased the risk of all-cause mortality at every stage of glucose intolerance.
Conclusion
A dose-dependent association between the risk of mortality from various causes and severity of glucose tolerance was noted in the elderly population.

Keyword

Diabetes mellitus; Aged; Glucose tolerance; Mortality

Figure

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  Fig. 1. Risk of cause-specific mortality in elderly people according to the glucose spectrum in age subgroups. (A) All-cause mortality. (B) Circulatory system. (C) Respiratory system. (D) Neoplasms. (E) Genitourinary system. (F) Others. NGT, normal glucose tolerance; IFG, impaired fasting glucose; DM, diabetes mellitus; HR, hazard ratio; CI, confidence interval.

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  Fig. 2. Risk of all-cause mortality in elderly people across the glucose spectrum depending on their underlying diseases: (A) stroke, (B) heart failure (HF), and (C) chronic kidney disease (CKD). HR, hazard ratio; CI, confidence interval; NGT, normal glucose tolerance; IFG, impaired fasting glucose; DM, diabetes mellitus.

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