Glycaemic status, insulin resistance, and risk of infection-related mortality: a cohort study
Glycaemic status, insulin resistance, and risk of infection-related mortality: a cohort study
Importance: the impact of non-diabetic hyperglycaemia and insulin resistance on infection-related mortality risk remains unknown.
Objective: we investigated the association of glycaemic status and insulin resistance with infection-related mortality in individuals with and without diabetes.
Design: cohort study based on Kangbuk Samsung Health Study and national death records.
Participants: about 666 888 Korean adults who underwent fasting blood measurements including glucose, glycated haemoglobin (HbA1c), and insulin during health-screening examinations were followed for up to 15.8 years.
Main outcome and measures: infection-related mortality, therefore we used Cox proportional hazards regression analyses to estimate hazard ratios (HRs) and 95% CIs for infection-related mortality. Vital status and infection-related mortality were ascertained through national death records. Variable categories were created based on established cut-offs for glucose and HbA1c levels and homeostatic model assessment of insulin resistance (HOMA-IR) quintiles.
Results: during a median follow-up of 8.3 years, 313 infectious disease deaths were dentified. The associations of glucose and HbA1c levels with infection-related mortality were J-shaped (P for quadratic trend<.05). The multivariable-adjusted HR (95% CIs) for infection-related mortality comparing glucose levels <5, 5.6-6.9, and ≥7.0 mmol/L to 5.0–5.5 mmol/L (the reference) were 2.31 (1.47–3.64), 1.65 (1.05–2.60), and 3.41 (1.66–7.00), respectively. Among individuals without diabetes, the multivariable-adjusted HR for infection-related mortality for insulin resistance (HOMA-IR ≥75th centile versus <75th centile) was 1.55 (1.04–2.32).
Conclusions and relevance: both low and high glycaemic levels and insulin resistance were independently associated with increased infection-related mortality risk, indicating a possible role of abnormal glucose metabolism in increased infection-related mortality.
HbA1c, cohort study, glucose, infection, infection-related mortality, insulin resistance
Cheong, Hae Suk
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Chang, Yoosoo
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Kim, Yejin
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Joo, Eun-Jeong
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Kwon, Min-Jung
e88c3610-a617-41eb-89ec-755156bc078d
Wild, Sarah H
b777c734-69f1-4a11-8b23-9d9da57d9633
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Ryu, Seungho
efac0de3-0134-45b8-862d-d33b1311a482
14 February 2023
Cheong, Hae Suk
d5206c91-6336-450f-a08a-0f35b81c1a95
Chang, Yoosoo
0a346ece-e7b2-4423-aa02-5a0f8e0b42d0
Kim, Yejin
7f0169f2-9ea7-466f-8d02-f465f2108dce
Joo, Eun-Jeong
3a9e4984-f225-4cfb-bef1-1bb40f58cf6f
Kwon, Min-Jung
e88c3610-a617-41eb-89ec-755156bc078d
Wild, Sarah H
b777c734-69f1-4a11-8b23-9d9da57d9633
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Ryu, Seungho
efac0de3-0134-45b8-862d-d33b1311a482
Cheong, Hae Suk, Chang, Yoosoo, Kim, Yejin, Joo, Eun-Jeong, Kwon, Min-Jung, Wild, Sarah H, Byrne, Christopher and Ryu, Seungho
(2023)
Glycaemic status, insulin resistance, and risk of infection-related mortality: a cohort study.
European journal of endocrinology, 188 (2).
(doi:10.1093/ejendo/lvad011).
Abstract
Importance: the impact of non-diabetic hyperglycaemia and insulin resistance on infection-related mortality risk remains unknown.
Objective: we investigated the association of glycaemic status and insulin resistance with infection-related mortality in individuals with and without diabetes.
Design: cohort study based on Kangbuk Samsung Health Study and national death records.
Participants: about 666 888 Korean adults who underwent fasting blood measurements including glucose, glycated haemoglobin (HbA1c), and insulin during health-screening examinations were followed for up to 15.8 years.
Main outcome and measures: infection-related mortality, therefore we used Cox proportional hazards regression analyses to estimate hazard ratios (HRs) and 95% CIs for infection-related mortality. Vital status and infection-related mortality were ascertained through national death records. Variable categories were created based on established cut-offs for glucose and HbA1c levels and homeostatic model assessment of insulin resistance (HOMA-IR) quintiles.
Results: during a median follow-up of 8.3 years, 313 infectious disease deaths were dentified. The associations of glucose and HbA1c levels with infection-related mortality were J-shaped (P for quadratic trend<.05). The multivariable-adjusted HR (95% CIs) for infection-related mortality comparing glucose levels <5, 5.6-6.9, and ≥7.0 mmol/L to 5.0–5.5 mmol/L (the reference) were 2.31 (1.47–3.64), 1.65 (1.05–2.60), and 3.41 (1.66–7.00), respectively. Among individuals without diabetes, the multivariable-adjusted HR for infection-related mortality for insulin resistance (HOMA-IR ≥75th centile versus <75th centile) was 1.55 (1.04–2.32).
Conclusions and relevance: both low and high glycaemic levels and insulin resistance were independently associated with increased infection-related mortality risk, indicating a possible role of abnormal glucose metabolism in increased infection-related mortality.
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Accepted/In Press date: 24 January 2023
e-pub ahead of print date: 9 February 2023
Published date: 14 February 2023
Additional Information:
Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of (ESE) European Society of Endocrinology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Keywords:
HbA1c, cohort study, glucose, infection, infection-related mortality, insulin resistance
Identifiers
Local EPrints ID: 475188
URI: http://eprints.soton.ac.uk/id/eprint/475188
ISSN: 0804-4643
PURE UUID: 971e8dce-472e-418d-9574-690816f4a745
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Date deposited: 13 Mar 2023 17:52
Last modified: 17 Mar 2024 07:40
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Contributors
Author:
Hae Suk Cheong
Author:
Yoosoo Chang
Author:
Yejin Kim
Author:
Eun-Jeong Joo
Author:
Min-Jung Kwon
Author:
Sarah H Wild
Author:
Seungho Ryu
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