Associations of different definitions of prediabetes and diabetes with all-cause and cause-specific mortality: a nationally representative cohort study

Mei Zhang; Zi-Xin Qiu; Yue Wang; Xiao Zhang; Shi-Yu Zhao; Chun Li; Zhen-Ping Zhao; Shen-Han Xiang; An Pan; Li-Min Wang; Mai-Geng Zhou; Kai Huang; Gang Liu

doi:10.1016/j.mmr.2026.100028

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Associations of different definitions of prediabetes and diabetes with all-cause and cause-specific mortality: a nationally representative cohort study

RESEARCH | Updated：2026-05-11

- Associations of different definitions of prediabetes and diabetes with all-cause and cause-specific mortality: a nationally representative cohort study
- Military Medical Research (2026)
- Affiliations：
  
  National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
  Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  Clinical Center for Human Genomic Research, Union Hospital, Huazhong University of Science and Technology, Wuhan 430022, China
  Hubei Clinical Research Center of Metabolic and Cardiovascular Disease, Huazhong University of Science and Technology, Wuhan 430022, China
  Hubei Key Laboratory of Metabolic Abnormalities and Vascular Aging, Huazhong University of Science and Technology, Wuhan 430022, China
  Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  Center for Obesity and Diabetes Research, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
  Renmin Hospital, Wuhan University, Wuhan 430000, China
  State Key Laboratory of Metabolism and Regulation in Complex Organisms, Wuhan University, Wuhan 430000, China
- Author bio：
  
  *Li-Min Wang, wanglimin@ncncd.chinacdc.cn;
  Mai-Geng Zhou, zhoumaigeng@ncncd.chinacdc;
  Kai Huang, huangkai1@hust.edu.cn;
  Gang Liu, liugang026@hust.edu.cn
- Funds：
- DOI：10.1016/j.mmr.2026.100028
  CLC：
- Received：09 November 2025，
  
  Accepted：26 March 2026，
  
  Published：2026-04
- Accepted：
Scan QR Code
Zhang M, Qiu ZX, Wang Y, Zhang X, Zhao SY, Li C, et al. Associations of different definitions of prediabetes and diabetes with all-cause and cause-specific mortality: a nationally representative cohort study. Mil Med Res. 2026;13(1):100028.
DOI：

Zhang M, Qiu ZX, Wang Y, Zhang X, Zhao SY, Li C, et al. Associations of different definitions of prediabetes and diabetes with all-cause and cause-specific mortality: a nationally representative cohort study. Mil Med Res. 2026;13(1):100028. DOI： 10.1016/j.mmr.2026.100028.

摘要

Abstract

Background:

Different glycemic indicators and diagnostic criteria for prediabetes and diabetes identify overlapping but distinct populations. However

the extent to which these definitions lead to differences in estimated prevalence and associated health outcomes remains unclear. This study aimed to compare the prevalence of prediabetes and newly diagnosed diabetes across different glycemic indicators and diagnostic criteria

and to examine their associations with mortality and life expectancy.

Methods:

We analyzed data from 141

945 adults from a nationally representative cohort study (the 2013 cycle of China Chronic Disease and Risk Factors Surveillance) in China

with follow-up through December 2021. Using fasting plasma glucose (FPG)

2-hour postload glucose (2hPG)

and hemoglobin A1c (HbA1c) levels

prediabetes was defined according to the American Diabetes Association (ADA)

World Health Organization (WHO)

or International Expert Committee (IEC) criteria

and newly diagnosed diabetes was defined according to the ADA criteria. Cox proportional hazards regression models were used to estimate hazard ratios (

HRs

) of all-cause and cause-specific mortality associated with different definitions

with adjustment for demographic characteristics

socioeconomic status

lifestyle factors

dietary factors

and baseline comorbidities. Life expectancy was estimated using sex- and age-specific abridged life tables by in

tegrating population mortality rates with exposure-specific

HRs

and prevalence.

Results:

Prediabetes prevalence varied widely across glycemic indicators

with the highest estimate of 26.2% (95% CI 24.0–28.4) based on ADA FPG criteria and the lowest estimate of 3.0% (95% CI 2.8–3.2) based on IEC HbA1c criteria

while the prevalence of newly diagnosed diabetes was 4.4% (95% CI 4.1–4.8) based on ADA FPG

2.6% (95% CI 2.4–2.8) based on ADA HbA1c

and 3.6% (95% CI 3.3–3.8) based on ADA 2hPG. Over a median follow-up of 9.0 years

a total of 6924 deaths were documented. Compared with people with normoglycemia

prediabetes defined by FPG (either ADA or WHO criteria) was not significantly associated with increased risks of all-cause or cardiovascular disease (CVD) mortality (all

-values

0.05). In contrast

prediabetes defined by 2hPG or HbA1c (either ADA or IEC criteria)

was associated with higher risks of all-cause mortality (

HRs

ranged from 1.13 to 1.23; all

-values

0.001) and CVD mortality (

HRs

ranged from 1.12 to 1.25; all

-values

0.001). Prediabetes defined by 2hPG or HbA1c

but not FPG

was associated with 1.1–2.3 years reduction in life expectancy

with the largest loss observed for IEC HbA1c. In addition

diabetes defined by FPG

2hPG or HbA1c was each significantly associated with a higher risk of all-cause and CVD mortality (

HRs

ranged from 1.25 to 1.51; all

-values

0.001)

and a reduction in life expectancy (2.0–3.7 years). Furthermore

the 2hPG-based definition of prediabetes and diabetes was associated with mortality risk

independent of FPG and HbA1c levels.

Conclusions:

These findings suggest that reliance on FPG alone may fail to identify certain individuals at elevated mortality risk. In contrast

2hPG and HbA1c provide additional prognostic information beyond FPG.

关键词

Keywords

references

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