All-cause Mortality of High-normal Random Blood Glucose using Basic Demographics

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Abstract Background: The prevalence of diabetes has reached epidemic proportions both in the United States and worldwide. A recent World Health Organization (WHO) report has estimated the prevalence has quadrupled in just three decades and is directly responsible for the deaths of 1.5 million people worldwide. More than 80% of these deaths occur in low and middle income countries. The forecasted urban population in developing nations is expected to double by the year 2030, compared to the year 2000. Methods: We utilized a limited teaching dataset from the Framingham Heart Study to examine the relationship between blood glucose levels and mortality using a Multivariate Cox proportional hazards model, adjusting for age, gender, body mass index and blood pressure. We divided glucose according to four categories, with normal reflecting conventional “intensive” control, high-normal reflecting a higher glucose level and moderate and severe elevations for further comparison of relative mortality. Results: 3,270 subjects were followed for 20 years, of which 316 fell into a high normal blood glucose category and 2,885 subjects had a normal blood glucose. The relative risk of death in the high normal random blood glucose (RBG) group was 1.22 times that of those with a random normal blood glucose (95% CI: 1.021.45; pvalue = 0.030). Discussion: A high normal random glucose level with limited covariates may prognosticate a greater risk of allcause morbidity and mortality compared to low normal glucose levels. These findings may help to provide estimates of risk in low and middle-income countries, where there is limited access to healthcare and basic lab testing such as HgbA1c.