Aims/IntroductionTo analyze the association between HbA1c level and the risk of all‐cause mortality in community patients with type 2 diabetes mellitus, and to provide a scientific basis for the management of type 2 diabetes mellitus in the community.Materials and MethodsBased on a Zhejiang rural community type 2 diabetes mellitus cohort, a total of 10,310 patients with type 2 diabetes mellitus with complete baseline and follow‐up data were selected. The Cox proportional hazards regression model and the restricted cubic spline model were used to evaluate the relationship between the HbA1c level and the risk of all‐cause mortality.ResultsDuring a mean follow‐up of 5.5 years, 971 patients died. With HbA1c levels of 6.5–7.0% as the reference, after adjusting for relevant confounding factors, the HR(95%CI) of all‐cause mortality with HbA1c levels of <5.5%, 5.5–6.5%, 7.0–8.0%, 8.0–9.0%, and ≥9.0% were 1.53 (1.08–2.15), 0.97 (0.79–1.21), 1.14 (0.92–1.41), 1.44 (1.14–1.83), and 2.08 (1.68–2.58), respectively. The HbA1c level was associated with the risk of all‐cause mortality in a “J‐shaped” manner. The risk of all‐cause mortality was lowest when the HbA1c was 6.5–7.0%, and increased significantly when the HbA1c was ≥ 8.0% and the HbA1c was < 5.5% (P < 0.05). The risk of all‐cause death in the HbA1c 5.5–6.5% group and the 7.0–8.0% group was not significant compared with the reference group (P > 0.05).ConclusionsThe HbA1c levels were associated with the risk of all‐cause mortality in type 2 diabetes mellitus in a “J‐shaped” manner, a too high or a too low HbA1c level could increase the risk of death. Attention should be paid to the individual evaluation of patients and the setting of appropriate glycemic control goals.

中文翻译：

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糖化血红蛋白与社区 2 型糖尿病患者全因死亡风险之间的关联：一项前瞻性队列研究

目的/简介分析社区2型糖尿病患者HbA1c水平与全因死亡风险的关系，为社区2型糖尿病的管理提供科学依据。材料与方法基于浙江省农村社区2型糖尿病队列，共纳入10310例具有完整基线和随访数据的2型糖尿病患者。采用Cox比例风险回归模型和限制三次样条模型来评估HbA1c水平与全因死亡风险之间的关系。结果在平均5.5年的随访期间，971名患者死亡。以HbA1c水平6.5%~7.0%为参考，调整相关混杂因素后，HbA1c水平<5.5%、5.5%~6.5%、7.0%~8.0%、8.0的全因死亡率HR（95%CI） –9.0%和≥9.0%分别为1.53（1.08-2.15）、0.97（0.79-1.21）、1.14（0.92-1.41）、1.44（1.14-1.83）和2.08（1.68-2.58）。HbA1c 水平与全因死亡风险呈“J 形”相关。当 HbA1c 为 6.5-7.0% 时，全因死亡风险最低；当 HbA1c ≥ 8.0% 且 HbA1c < 5.5% 时，全因死亡风险显着增加（磷< 0.05）。HbA1c 5.5-6.5% 组和 7.0-8.0% 组的全因死亡风险与参考组相比并不显着（磷> 0.05）。结论 HbA1c水平与2型糖尿病全因死亡风险呈“J型”相关，HbA1c水平过高或过低均会增加死亡风险。应注意患者的个体化评估和设定适当的血糖控制目标。