Diabetes with poor-control HbA1c is cardiovascular disease ‘risk equivalent’ for mortality: UK Biobank and Hong Kong population-based cohort study
Authors' conclusion
Patients with T2DM with poor HbA1c control (8%-8.9% and ≥9%) were associated with similar and higher risk of mortality compared with patients with CVD, respectively. Optimal HbA1c, controlled for risk reduction and prevention of mortality and complications in diabetes management, remains important.
Study context
- Population
- Adults in Hong Kong (3,839,391) and the UK Biobank (497,779)two cohorts
- Exposure
- T2D and/or cardiovascular disease (CVD) groups, with T2D stratified by HbA1c, vs no T2D and CVD
- Outcome
- All-cause mortality
- Follow-up
- Around 10 years of median
Methodological detailsretrospective Hong Kong cohort and prospective UK Biobank cohort, Cox regression
- Retrospective Hong Kong cohort and prospective UK Biobank cohort
- Cox regression
Main finding
As reported in the abstract
All-cause mortality (adjusted HR vs no T2DM and CVD)
Each group vs no T2DM and CVDEstimate (95% CI)
T2DM only HbA1c <7%Hong Kong cohort
adjusted HR 1.25(1.23–1.27)
T2DM only HbA1c 7%-7.9%Hong Kong cohort
adjusted HR 1.21(1.19–1.23)
T2DM only HbA1c 8%-8.9%Hong Kong cohort
adjusted HR 1.36(1.33–1.39)
T2DM only HbA1c ≥9%Hong Kong cohort
adjusted HR 1.82(1.78–1.85)
CVD onlyHong Kong cohort
adjusted HR 1.37(1.36–1.38)
T2DM and CVDHong Kong cohort
adjusted HR 1.83(1.81–1.85)
T2DM only HbA1c <7%UK Biobank
HR 1.45(1.33–1.58)
T2DM only HbA1c 7%-7.9%UK Biobank
HR 1.50(1.32–1.70)
T2DM only HbA1c 8%-8.9%UK Biobank
HR 1.72(1.43–2.08)
T2DM only HbA1c ≥9%UK Biobank
HR 2.51(2.05–3.08)
CVD onlyUK Biobank
HR 1.67(1.59–1.75)
T2DM and CVDUK Biobank
HR 2.62(2.42–2.83)
- Deaths, Hong Kong cohort
- 423 818
- Deaths, UK Biobank
- 19 844
Observational data: associations, not effects.
Original publication
Diabetes with poor-control HbA1c is cardiovascular disease ‘risk equivalent’ for mortality: UK Biobank and Hong Kong population-based cohort study. BMJ Open Diabetes Res Care. Published 12 January 2023. doi:10.
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