The impact of diabetes mellitus and corresponding HbA1c levels on the future risks of cardiovascular disease and mortality: a representative cohort study in Taiwan
Open accessAbstract
BACKGROUND: This study explored the relationship between the glycated hemoglobin (HbA1c) level in patients with or without diabetes mellitus and future risks of cardiovascular disease and death. METHODS: Based on a national representative cohort, a total of 5277 participants (7% with diabetes) were selected from Taiwan's Triple High Survey in 2002. The comorbidities, medication usages, and outcomes of cardiovascular disease and death, were extracted from the Taiwan's National Health Insurance Research Database and National Death Registry. RESULTS: After a median follow-up of 9.7 years, participants with diabetes had higher incidence of new onset cardiovascular disease (17.9 versus 3.16 cases per 1000 person-years) and death (20.1 versus 4.96 cases per 1000 person-years) than those without diabetes (all P < 0.001). Diabetes showed increased risk of all-cause death after adjusting for all confounders (adjusted hazard ratio [HR]: 2.29, 95% confidence interval [CI]: 1.52-3.45). Every 1% increment of HbA1c was positively associated with the risk of total cardiovascular disease (HR: 1.2, 95% CI: 1.08-1.34) and the risk of death (HR: 1.14, 95% CI: 1.03-1.26) for all participants. As compared to the reference group with HbA1c below 5.5%, participants with HbA1c levels ≥7.5% had significantly elevated future risks of total cardiovascular disease (HR: 1.82, 95% CI: 1.01-3.26) and all-cause death (HR: 2.45, 95% CI: 1.45-4.14). CONCLUSIONS/INTERPRETATION: Elevated HbA1C levels were associated with increased risks of cardiovascular disease and death, the suboptimal glycemic control with HbA1c level over 7.5% (58.5 mmol/mol) was strongly associated with increased risks of cardiovascular disease and all-cause death.
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The optimal physical activity dose can achieve a decrease of up to >1% for patients with severe uncontrolled diabetes, attenuating the risk of microvascular complications, macrovascular complications, and diabetes all-cause mortality.
“The optimal physical activity dose here represents a more objective approach, use of which can achieve a decrease of up to >1% for patients with severe uncontrolled diabetes, attenuating the risk of microvascular complications, macrovascular complications, and diabetes all-cause mortality (30).”
From Optimal Dose and Type of Physical Activity to Improve Glycemic Control in People Diagnosed With Type 2 Diabetes: A Systematic Review and Meta-analysis (2024) · cites this paper as [30]
The Results (page unavailable) associate higher HbA1c with greater cardiovascular and all-cause mortality risk, supporting the claim’s general link between glycemic control and those outcomes. The paper does not show that an optimal physical-activity dose lowers HbA1c by more than 1% in patients with severe uncontrolled diabetes, or that it reduces microvascular complications. Its observational associations do not establish the claimed effect of physical activity. (LLM, conf=0.88)
Experimental — accuracy not yet measuredHbA1c levels below the <7% threshold could reduce risk of ischemic stroke, coronary heart disease, and cardiovascular disease for patients with diabetes, metabolic disease, neuropathy, nephropathy, and peripheral vascular disease.
“HbA 1c levels below this threshold could reduce risk of ischemic stroke, coronary heart disease, and cardiovascular disease (30) for patients with diabetes, metabolic disease, neuropathy, nephropathy, and peripheral vascular disease (31).”
From Optimal Dose and Type of Physical Activity to Improve Glycemic Control in People Diagnosed With Type 2 Diabetes: A Systematic Review and Meta-analysis (2024) · cites this paper as [30]
The Results associate higher HbA1c with greater risks of ischemic stroke, coronary heart disease, and cardiovascular disease; the Discussion says these findings might support an HbA1c target below 7%. The study does not establish that lowering HbA1c below 7% reduces those risks: its significant comparison uses ≥7.5%, and the evidence is observational. The list of patient conditions is attached to a separate citation (31), not this source. Page numbers are unavailable in our copy. (LLM, conf=0.85)
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- Authors
- Chen, Y.-Y., Lin, Y.-J., Chong, E., Chen, P.-C., Chao, T.-F., Chen, S.-A., & Chien, K.-L.
- Affiliations
- National Taiwan University (TW)
- Taipei Veterans General Hospital (TW)
- Corresponding author
- Chien, Kuo-Liong
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-04-13
- Volume
- 10
- Issue
- 4
- Pages
- e0123116
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4395238
- OpenAlex
- W1986135044
- Cited by
- 56
- References
- 31
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 8 · 2023: 4 · 2022: 4 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 11 · 2017: 5 · 2016: 3 · 2015: 1
- FWCI
- 5.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- National University of Singapore (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Ministry of Health and Welfare
- National Science Council
- Taipei Veterans General Hospital
- Health Promotion Administration, Ministry of Health and Welfare
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetes mellitus, HbA1c, cardiovascular disease, all-cause mortality, glycemic control, cardiovascular risk
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Diabetes Mellitus, Female, Glycated Hemoglobin, Humans, Hyperglycemia, Hyperlipidemias, Male, Middle Aged, Mortality, Registries, Retrospective Studies, Risk Factors, Taiwan, Proportional Hazards Models
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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