Diabetes research and clinical practice · 2026
U-shaped association between the GA/HbA1c ratio and all-cause and cardiovascular mortality among patients with type 2 diabetes: A real-world study.
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Xu Yiting, Li Qi, Wang Ming, Hu Tingting, Wang Chunfang, Shen Yun, Wu Liang, Du Ronghui, Wang Yufei, Ma Xiaojing, Xia Tian, Bao Yuqian
Аннотация
AIMS: To explore the association between the glycated albumin to hemoglobin A1c (GA/HbA1c) ratio and all-cause and cardiovascular mortality among adults with type 2 diabetes.
METHODS: We used data from the PREMIRE cohort, which was established among patients with type 2 diabetes using electronic health records. The baseline GA/HbA1c ratio was calculated from the first available measurements of GA and HbA1c during the patient's initial visit to the hospital for type 2 diabetes.
RESULTS: The study included 20,012 participants, and 3,293 deaths occurred, including 1,313 cardiovascular deaths over a median follow-up of 3.39 years. The GA/HbA1c ratio serves as a robust predictor of mortality, offering superior discriminative ability compared with GA or HbA1c alone. RCS analysis revealed a U-shaped association between the ratio and mortality. The ratio > 3.00 was associated with increased all-cause [HR 1.60 (95% CI, 1.49-1.73)] and cardiovascular mortality [HR 1.61 (95% CI, 1.43-1.81)], while the ratio < 2.00 was also associated with higher all-cause [HR 1.89 (95% CI, 1.64-2.18)] and cardiovascular mortality [HR 1.61 (95% CI, 1.26-2.06)]. The association is further validated in the National Health and Nutrition Examination Survey 1999-2004.
CONCLUSIONS: The GA/HbA1c ratio was significantly and independently associated with both all-cause and cardiovascular mortality, following a U-shaped pattern.
METHODS: We used data from the PREMIRE cohort, which was established among patients with type 2 diabetes using electronic health records. The baseline GA/HbA1c ratio was calculated from the first available measurements of GA and HbA1c during the patient's initial visit to the hospital for type 2 diabetes.
RESULTS: The study included 20,012 participants, and 3,293 deaths occurred, including 1,313 cardiovascular deaths over a median follow-up of 3.39 years. The GA/HbA1c ratio serves as a robust predictor of mortality, offering superior discriminative ability compared with GA or HbA1c alone. RCS analysis revealed a U-shaped association between the ratio and mortality. The ratio > 3.00 was associated with increased all-cause [HR 1.60 (95% CI, 1.49-1.73)] and cardiovascular mortality [HR 1.61 (95% CI, 1.43-1.81)], while the ratio < 2.00 was also associated with higher all-cause [HR 1.89 (95% CI, 1.64-2.18)] and cardiovascular mortality [HR 1.61 (95% CI, 1.26-2.06)]. The association is further validated in the National Health and Nutrition Examination Survey 1999-2004.
CONCLUSIONS: The GA/HbA1c ratio was significantly and independently associated with both all-cause and cardiovascular mortality, following a U-shaped pattern.