This study assessed the relationship between random blood glucose levels and all-cause mortality using data from the Framingham Heart Study. The study followed 3,270 subjects for 20 years and found that subjects with high-normal random glucose levels (100-139 mg/dL) had a 22% higher rate of mortality compared to those with normal glucose levels, after adjusting for age, BMI, and blood pressure. The results suggest that elevated random glucose levels, even in the high-normal range, may be a risk factor for increased mortality.

1. Assessing the Relationship Between Random Glucose and All-Cause Mortality
Sunil E. Saith, MD, MPH, Jun S. Tang Ph.D, Shamma Al Memari, MBBS, Afra Al-Dhaheri, MBBS, Andrew Kohut, MD, MPH
Department of Internal Medicine, NYU Lutheran Medical Center, Brooklyn, NY, Dept. of Clin. Pharmacy, School of Pharmacy, UCSF, Sheikh
Khalifa Medical City, Abu Dhabi, UAE, Tawam Hospital, Al Ain, UAE, Division of Cardiology, Drexel School of Medicine, Philadelphia, PA
Introduction
 Diabetes is a risk factor for cardiovascular
disease and all-cause mortality.
 Additionally, there is evidence that elevated
blood glucose levels in non-diabetics may
increase morbidity and mortality via
increased risk of developing diabetes or
cardiovascular disease.
 However, unlike the International Diabetes
Foundation, the American Diabetes
Association has no formal protocol to
guide diagnostic management of random
blood glucose measurements.
 Our objective was to assess whether a
high-normal random glucose level confers
an increased risk of mortality, when
adjusted for other covariates.
Methods
 With permission of the Framingham Heart
Study, we conducted a retrospective cohort
analysis using a teaching dataset in 2013.
 Glucose was categorized as normal (70-99
mg/dL), high-normal (100-139 mg/dL),
moderately high (140-199 mg/dL) and
severely high (greater than 200 mg/dL).
Statistical analysis was performed using
SAS ® version 9.3.
 We examined the relationship between
time to all-cause death and random
glucose using Cox proportionate hazards
models, both unadjusted and adjusted for
age, BMI, systolic blood pressure, and
diastolic blood pressure.
Results
 3,270 subjects were followed for 20 years, of
which 316 fell into a high normal blood
glucose category and 2,885 subjects had a
normal random blood glucose.
 The multivariate analysis revealed that
subjects in the high-normal random glucose
category had 1.22 times the rate of mortality
compared to normal blood glucose level
(95% CI: 1.02-1.45 p-value = 0.030).
Limitations and Strengths
 Blood glucose reported may actually
represent a fasting, rather than a random
glucose level. Subjects who fell in the high-
normal glucose category were also likely to
be older, overweight or hypertensive.
 Our results, using limited co-variates, are
consistent with 20-year follow-up in middle-
aged, non-diabetic men: Whitehall Study,
Paris Prospective and the Helsinki
Policeman Studies.
Conclusions
 Using age, gender, BMI and blood pressure,
in conjunction with a random glucose level,
may offer some insight into cardiovascular
mortality with limited, low-tech resources.
 Clinical validation of our model may aide in
re-defining at-risk populations and a re-
examination of primary prevention efforts, to
offset the growing diabetes epidemic.
Total Normal High-
Normal
Moderately
High
Severely High P-value
Age (S.D.) 50 (8.68) 50 (8.70) 52 (8.50) 55 (8.90) 56 (6.60) <0.0001*
Gender
Male
Female
1445 (44.19)
1825 (55.81)
1260 (43.67)
1625 (56.33)
148 (46.84)
168 (53.16)
21 (63.64)
12 (36.36)
16 (44.44)
20 (55.56)
0.0992
BMI
Normal
Overweight
Obese
1422 (44.02)
1372 (42.48)
436 (13.50)
1293 (45.37)
1196 (41.96)
361 (12.67)
114 (36.31)
145 (46.18)
55 (17.52)
7 (21.88)
15 (46.88)
10 (31.25)
8 (23.53)
16 (47.06)
10 (29.41)
0.0007*
Systolic BP
< 120
120-139
140-159
> 160
913 (27.95)
1295 (39.65)
642 (19.66)
416 (12.74)
839 (29.1)
1151 (39.92)
550 (19.08)
343 (11.90)
61 (19.3)
123 (38.92)
79 (25)
53 (16.77)
7 (21.88)
11 (34.38)
8 (25)
6 (18.75)
6 (17.14)
10 (28.57)
5 (14.29)
14 (40)
<0.0001*
Diastolic BP
< 80
80-89
90-99
>100
1253 (38.45)
1158 (35.53)
574 (17.61)
274 (8.41)
1123 (39.05)
1021 (35.5)
495 (17.21)
237 (8.24)
107 (34.08)
115 (36.62)
65 (20.7)
27 (8.6)
11 (33.33)
13 (39.39)
4 (12.12)
5 (15.15)
12 (33.33)
9 (25)
10 (27.78)
5 (13.89)
0.2437
Table 1: Demographics (n,%)
Estimate (+ SE) Hazard Ratio C.I. (95%) P-value
Age 0.0838 (0.00397) 1.087 1.079 – 1.096 <0.0001
Female -0.75055 (0.06117) 0.472 0.419 – 0.532 < 0.0001
Glucose
High normal
Moderate
Severe
0.19531 (0.08989)
0.89922 (0.20414)
1.15182 (0.18211)
1.216
2.458
3.164
1.019 – 1.45
1.647 – 3.667
2.214 – 4.521
0.0298
<0.0001
<0.0001
BMI
Obese
Overweight
0.06858 (0.09099)
-0.0942 (0.06644)
1.071
0.91
0.896 – 1.28
0.799 – 1.037
0.451
0.1563
SBP
120-139
140-159
>160
0.22088 (0.09195)
0.47621 (0.11295)
0.80143 (0.13484)
1.247
1.61
2.229
1.041 – 1.493
1.29 – 2.009
1.711 – 2.903
0.0163
<0.0001
<0.0001
DBP
80-89
90-99
-0.05685 (0.0808)
0.06481 (0.10311)
0.945
1.067
0.806 – 1.107
0.872 – 1.306
0.0163
<0.0001
Table 2: Multivariate Cox regression results