ArticleDiabetologia2011
No evidence of an increased mortality risk associated with low levels of glycated haemoglobin in a non-diabetic UK population.
Article in Diabetologia, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.
- HbA1c and Risks of All-Cause and Cause-Specific Death in Subjects without Known Diabetes: A Dose-Response Meta-Analysis of Prospective Cohort Studies.Scientific reports · 2016Pooled it
- Pooled it
- Interplay of glycated hemoglobin and traditional risk factors for the risk of atherosclerotic cardiovascular disease and all-cause mortality in people without diabetes.Cardiovascular diabetology · 2025Observational
- Prevalence of prediabetes and associated factors of prediabetic stages: a cross-sectional study among adults in Nepal.BMJ open · 2022Article
- Glycated haemoglobin levels among 3295 hospitalized COVID-19 patients, with and without diabetes, and risk of severe infection, admission to an intensive care unit and all-cause mortality.Diabetes, obesity & metabolism · 2022Article
- Association of glycated hemoglobin ACardiovascular diabetology · 2021Article
- Metabolic Dysfunction in Spinal Muscular Atrophy.International journal of molecular sciences · 2021Review
- Glycaemic markers and all-cause mortality in older adults with and without diabetes: the Atherosclerosis Risk in Communities (ARIC) study.Diabetologia · 2021Article
- Lower carbohydrate and higher fat intakes are associated with higher hemoglobin A1c: findings from the UK National Diet and Nutrition Survey 2008-2016.European journal of nutrition · 2020Article
- Glycated Hemoglobin and All-Cause and Cause-Specific Mortality Among Adults With and Without Diabetes.The Journal of clinical endocrinology and metabolism · 2019Article
- An investigation into the relationship between plain water intake and glycated Hb (HbA1c): a sex-stratified, cross-sectional analysis of the UK National Diet and Nutrition Survey (2008-2012).The British journal of nutrition · 2017Article
- A prospective study of low fasting glucose with cardiovascular disease events and all-cause mortality: The Women's Health Initiative.Metabolism: clinical and experimental · 2017Article
- Association of high normal HbA1c and TSH levels with the risk of CHD: a 10-year cohort study and SVM analysis.Scientific reports · 2017Article
- Novel biomarkers for prediabetes, diabetes, and associated complications.Diabetes, metabolic syndrome and obesity : targets and therapy · 2017Review
- Article
- Glycated hemoglobin and all-cause and cause-specific mortality in Singaporean Chinese without diagnosed diabetes: the Singapore Chinese Health Study.Diabetes care · 2014Article
- We can change the natural history of type 2 diabetes.Diabetes care · 2014Article
- Article
- Low hemoglobin A(1c) in nondiabetic adults: an elevated risk state?Diabetes care · 2012Article
- Low HbA1c and mortality: causation and confounding.Diabetologia · 2012Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
aims/hypothesisThere is debate about increased mortality risk associated with low levels of glycaemia. To address this issue, we examined the shape of the risk relationship between glycated haemoglobin and mortality in a UK population.
methodsIn 17,196 men and women aged 39-82 years participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study in Norfolk without known diabetes or cardiovascular disease, we estimated HRs for total and cause-specific mortality comparing categories of glycated haemoglobin (<4.5%, 4.5% to <5.0%, 5.0% to <5.5% [reference], 5.5% to <6.0%, 6.0% to <6.5%, and ≥6.5%) using Cox regression.
resultsDuring a mean (±SD) follow-up of 11.2 (±2.1) years 1,953 participants died. The HR for all-cause mortality increased with categories of increasing glycated haemoglobin in adjusted analyses (HR 0.94 [95% CI 0.72-1.22], 0.99 [0.86-1.13], 1.00 [0.92-1.08], 1.10 [1.02-1.19], 1.29 [1.14-1.46] and 1.45 [1.16-1.80]). Spline regression suggested no increased risk at the low end of the distribution. Indeed, the HR for all-cause mortality was virtually constant in the low range and only started to rise when the level was approximately 5.5%. There were similar associations of glycated haemoglobin with cause-specific mortality, with the strongest association being seen for cardiovascular mortality. CONCLUSIONS/
interpretationOur findings in a large non-diabetic population do not support the concern about increased mortality risk with low glycated haemoglobin. Differences in population characteristics might explain contrary results of earlier studies and need further exploration.
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