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Introduction
Diabetes is a worldwide epidemic. Fasting glucose measurement remains the main test for the diagnosis of diabetes and prediabetes, and it is a key indicator of future diabetes and cardiovascular disease1, 2. However, the current cut-points, for example, 100 or 110 mg/dL for prediabetes, are somewhat arbitrarily chosen due to inconsistent results in prior studies1,2,3,4,5,6. Identifying proper cut-points for fasting glucose and overall mortality would help inform public and clinical actions to prevent premature death from health issues related to hyperglycemia and hypoglycemia.
Although fasting glucose levels are generally known to increase with advancing age7,8,9 and may differ by sex8,9,10, the sex- and age-specific associations of fasting glucose with all-cause mortality have rarely been examined. It is unclear whether variation according to age and sex is present in the association between fasting glucose and the risk of death and/or the range of fasting glucose associated with a minimal risk of death7, 11, 12. Additionally, age- and sex-specific fasting glucose concentrations may differ across ethnic and regional groups8, 9, 13, meaning that the association of fasting glucose levels with diseases and mortality may also vary by ethnicity14. Furthermore, detailed sex- and age-specific fasting glucose concentrations in the Korean population have not been reported.
Through a large prospective cohort study that included 12.8 million participants, we set out to elucidate whether the association between fasting glucose levels and all-cause mortality varies by sex and age, and to estimate sex- and age-specific levels of fasting glucose associated with minimal mortality. Precise estimates could help determine cut points for the management of hyperglycemia and hypoglycemia. Additionally, detailed estimates of mean [and median] concentrations of fasting glucose according to sex and age could help in the management of sex- and age- specific aspects of glucose metabolism and related metabolic disorders.
Methods
Study population and follow-up
The National Health Insurance Service [NHIS] provides compulsory health insurance that covers 97% of the Korean population. The Korean Metabolic Risk factor [KOMERIT] study was designed primarily to assess the risk of death associated with metabolic risk factors, and includes 12,845,017 NHIS beneficiaries aged 18–99 years who participated in routine health examinations during 2001–200415. Individuals with missing information on serum glucose, blood pressure, total cholesterol, and body-mass index [BMI] were excluded [n = 26,136], as were 3,665 persons with extremely low weight [