Postchallenge hyperglycemia and mortality in a national sample of US adults

OBJECTIVE - Although postchallenge hyperglycemia is a well-established feature of type 2 diabetes, its association with risk of mortality is uncertain. Therefore, the aim of this study was, to assess the independent association of fasting and 2-h glucose levels with all-cause and cardiovascular disease (CVD) mortality. RESEARCH DESIGN AND METHODS - We analyzed data from the Second National Health and Nutrition Examination Survey (NHANES 11) Mortality Study, a prospective cohort study of U.S. adults examined in the NHANES 11, and focused on the 3,092 adults aged 30-74 years who underwent an oral glucose tolerance test at. baseline (1976-1980). Deaths were identified from U.S. national mortality files from 1976 to 1992, To account for the complex survey design, we used SUDAAN statistical software for weighted analysis. RESULTS - Compared with their normoglycemic counterparts (fasting glucose [FG] <7.0 and 2-h glucose <7.8 mmol/l), adults with fasting and postchallenge hyperglycemia (FG greater than or equal to7.0 and 2-h glucose greater than or equal to 11.1 mmol/l) had a twofold higher risk of death after 16 years of follow-up (age- and sex-adjusted relative hazard [RH] 2.1, 95% CI 1.4-3.2). However, adults with isolated postchallenge hyperglycemia (FG <7.0 and 2-h glucose 11.1 mmol/l) were also at higher risk of death (1.6, 1.0-2.6). In proportional hazards analysis, FG (fully adjusted RH 1.10 per I SD AND 95% CI 1.01, 1.22) and 2-h glucose (1, 14, 1.00-1.29) showed nearly identical predictive value for mortality. Similar trends were observed for CVD mortality. CONCLUSIONS - These results suggest that postchallenge hyperglycemia is associated with increased risk of all-cause and CVD mortality independently of Other CVD risk factors.