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Epidemiology
Research
Low fasting glucose and future risks of major adverse outcomes in people without baseline diabetes or cardiovascular disease: a systematic review and meta-analysis
  1. Hung-Wei Liao1,
  2. Jeffrey Saver2,
  3. Hsin-Chieh Yeh3,
  4. Chi-Hsin Sally Chen4,
  5. Yi-Ling Wu5,
  6. Meng Lee6,
  7. Bruce Ovbiagele7
  1. 1Department of Nephrology, Chinru Clinic, Taipei, Taiwan
  2. 2Department of Neurology, University of California System, Los Angeles, California, USA
  3. 3School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  4. 4College of Public Health, National Taiwan University, Taipei, Taiwan
  5. 5Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
  6. 6Department of Neurology, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan
  7. 7Department of Neurology, University of California System, San Francisco, California, USA
  1. Correspondence to Dr Meng Lee; menglee5126{at}gmail.com

Abstract

Objective To investigate the link between low fasting blood glucose levels and all-cause mortality and cardiovascular outcomes among people without baseline diabetes or cardiovascular disease.

Design Systematic review and meta-analysis.

Data sources PubMed and Embase (1966–February 2019).

Selection criteria Prospective cohort studies were included for meta-analysis if they reported adjusted HRs with 95% CIs for associations between risk of all-cause mortality, stroke, major cardiovascular events, coronary heart disease and low fasting glucose levels (<4.6 mmol/L and/or 4.0 mmol/L, respectively) versus normal fasting glucose levels.

Data extraction and statistical analysis Two independent reviewers extracted data from eligible studies. Heterogeneity was assessed by p value of χ2 tests and I2. We assessed four characteristics for each included study based on items developed by the US Preventive Task Force, as well as the modified checklist used in previous studies.

Results Eleven articles (consisting of 129 prospective cohort studies) with 2 674 882 participants without diabetes and cardiovascular disease at baseline were included in this meta-analysis. Pooled results from the random effects model showed increased risks of all-cause mortality (HR: 1.56; 95% CI 1.09 to 2.23), total stroke (HR: 1.08, 95% CI 1.03 to 1.13) and ischaemic stroke (HR: 1.06, 95% CI 1.01 to 1.10), and major cardiovascular events (HR: 1.05, 95% CI 1.03 to 1.07) among people with a fasting glucose <4.0 mmol/L, as compared with people with normal fasting glucose. The less stringent low fasting glucose level, <4.6 mmol/L, was not associated with increased risk of any endpoints.

Discussion and conclusions Among people without baseline diabetes or cardiovascular disease, a fasting blood glucose level of <4.0 mmol/L is associated with increased risk of all-cause mortality, major cardiovascular events and stroke.

  • epidemiology
  • primary care
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-026010

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    Footnotes

    • Contributors H-WL: acquisition of data, analysis and interpretation of data and wrote the first draft. JS: analysis and interpretation of data and critical revision of manuscript for intellectual content. H-CY: critical revision of manuscript for intellectual content. C-HSC: acquisition of data and critical revision of manuscript for intellectual content. Y-LW: acquisition of data and analysis and interpretation of data. ML: study concept and design, acquisition of data, analysis and interpretation of data and critical revision of manuscript for intellectual content. BO: study supervision and critical revision of manuscript for intellectual content.

    • Funding This work was supported by Ministry of Science and Technology, Taiwan, grant number: MOST105-2628-B-182-008-MY2 and Chang Gung Memorial Hospital, Taiwan, grant numbers: CORPG6D0101, CORPG6D0102 and CORPG6D0103.

    • Disclaimer The sponsors played no role in the study design, data collection and analysis, or decision to submit the article for publication.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.

    • Patient consent for publication Not required.