Diabetes, Fasting Glucose Analysis, And How Likely Am I To Die Anyway?
Hello everyone, it's been a bit since my last science related posting and I think it's time to get back at it! Today we are going to discuss an article published in the journal Nature: Scientific Reports titled "Association between fasting glucose and all-cause mortality according to sex and age: a prospective cohort study".
In this article the authors were looking at whether or not monitoring blood glucose levels in a fasted state (which begins around 12 hours after eating), is actually a good indicator of mortality (aka how long you are likely to live). Most of you (well probably all of you ) are familiar with the fact that higher blood glucose levels are symptomatic of diabetes, and that diabetes is associated with a variety of negative health effects. So the actual findings of this article may not be particularly surprising. However there is another reason why I want to discuss this article with you all. That pertains to how we should think about data when we see it. This article presents us with lots of nice data that we can use to hone our critical thinking and interpretive skills and in our modern internet connected and information filled world, strong analytical reasoning skills are becoming increasingly important.
Diabetes
Diabetes mellitus (or just diabetes) is a term given to a set of diseases (type 1 which people are born with, and type 2 which develops typically in adulthood) characterized by increased blood glucose concentrations. Unchecked diabetes can lead to a whole host of health issues including heart disease, kidney disease, and even damage to the central nervous system.
One way that diabetes is commonly diagnosed is through a physicians analysis of your fasting blood glucose concentration. A healthy blood glucose concentration is typically 70 - 100 milligrams glucose per deciliter of blood (coincidentally an average person will have around 5 liters of blood, which means in a fasted state all of that blood in total should only have dissolved in it around 3.5 - 5 g of glucose (or around the 10% of the amount that is in one 20 oz bottle of soda, yes yes I know soda is mostly fructose and sucrose... but the sucrose fraction is a disaccharide composed of one glucose and one fructose, so there's still around 25-35 g of glucose in there). Thanks to @cryspano for correcting my awful math.
Some Background Info On The Studies Methodology
In this article the authors divided people (12,455,361 people to be exact) up into eight separate classes based on their blood glucose levels:
<70, 70–79, 80–94, 95–99, 100–109, 110–125, ≥126 [126–179, ≥180 mg/dL]
and then explored the relationships between the mortality of the studies subjects and where they fell in these eight groups.
Some Interesting Data From The Article
One of the first things the authors discussed was just how blood glucose levels are not static as we age. On the contrary they increase with age, and also interestingly those age related changes are different for men and women.
In Figure 1A from the article (shown to the left) we can see the average fasting blood glucose concentrations for both men (green) and women (red) plotted with respect to their age. Women, interestingly, have significantly lower fasting blood glucose levels (on average) then men all the way until around 72 years of age. What you can take note of when looking at this data is that no matter the age, in general the average person falls within the "healthy" concentration we talked about above (70 - 100 mg/dL).
Some separate questions I have for you. 1.) Looking at the plot we see that the blood glucose levels of women appear to go a bit higher then men. Additionally the trend for women doesn't appear to plateau like it does for men. 2.) Would you expect that the overall blood glucose levels for women would continue to increase (for women) were data available for a cohort of people aged 90? I ask these questions because looking at the available data and making INFORMED assessments of what it is telling you is an important skill.
So lets try to answer those questions. 1.) The datapoints here are averages, thus they are the summation of a LOT of individual blood glucose levels. Thus they have a range associated with each of them, often times this range is represented as error bars that extend above and below the data point. As we are not presented with this range for either the men or women it is not possible given this plot to say that the blood glucose levels between the men and women are different beyond age 72. The argument could be supported that they are based upon the very large sample size included in this study, however my question pertains to analyzing this plot. 2.) The answer to this is maybe, but the trend is reliant on only one point 88 yrs, so no reasonable extrapolation should be made. The prior few data points look as though the glucose levels for women are also leveling off (like we see for men), however the point at 88 yrs appears to jump up for women. It is difficult to conclude that this trend is maintaining linearity based upon just this one data point.
Relationship Between Mortality And Blood Glucose Level?
Another aspect of their analysis was looking at the likelihood of death with respect to the blood glucose levels. On the plot to the right (Figure 2B) that likelihood is displayed as a "hazard-ratio." We see that the lowest hazard ratio is centered around 90 mg/dL glucose in the blood, lower amounts then that lead to an increased occurrence of death and higher values lead to a significantly higher risk of death. The trends look similar for both men and women.
If you have been reading my blogs then this "hazard-ratio" term is one you are likely familiar with (as we have talked about it before, so if you are familiar... great! You can skip this next box, for those that do not know, see the box below!)
So [hazard ratio](http://www.statisticshowto.com/hazard-ratio/) represents the increase in the chance that a particular group of people will (in this case die) compared to a different group. In the data sets below the various different glucose concentrations were compared with a healthy level (~90 mg/dL) you can see that the hazard ratio around that 90 mg/dL concentration is 1. If a given fasting blood glucose concentration resulted in someone being 50% more likely to die their hazard ratio would be 1.5. If they were 200% more likely to die then the hazard ratio would be 3 (as they would die at 300% the rate).
All Age Groups Show An Increased Chance Of Mortality Relative To Fasting Blood Glucose Concentrations
How about we just look at two extremes, some young people and some old people.
You can see that both age groups that I have picked out from the article show the trend of an increasing hazard ratio that we discussed above for the overall data. However here I have a question for you. Why is the hazard ratio increasing to such a large number for the young age group, but not for the older age group? Give your guesses in the comments :) You just might get some nice votes for sharing your opinions. Please begin your comment with: Young Vs. Old Hazard Ratio then explain why you think this discrepancy exists or what this means.
Conclusions/TL;DR
The article shows that blood glucose levels are in fact a good indicator of potential mortality. The data illustrates that blood glucose levels in the range of 80 - 94 mg/dL are the best for having the lowest risk of death from health complications.
I hope you found this article interesting, and at least thought provoking from a data interpretation standpoint.
Sources
- https://www.nature.com/articles/s41598-017-08498-6
- http://www.nfs.uvm.edu/nfs-new/activities/tutorials/Integration.html
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600176/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170131/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4398900/
- http://www.statisticshowto.com/hazard-ratio/
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I was about to say that for answering your first two questions, it would be necessary to get the error bars, that may also help us to understand which proportion of the participants are filling each age category.
And to answer the last one, over the young vs old hazard ratio, we must be careful of the fact that the error bars for the young guys are way higher. Before developing my thought, I am wondering whether the band corresponds to a 1sigma or 2sigma spread. In the former case, the would be discrepancy is also kind of compatible with a no discrepancy at all, the differences between both being below 2 sigmas.
If we forget about the error bar, shouldn't we take figure 1 into account to get a clue?
PS: it was nice to read from you after such a long time! Your divulgation skills are actually way better than mine :)
Your point for the error in the second figure is good to keep in consideration. How confident can we really be that there is a statistically relevant difference between those two age groupings. There is clearly a huge variance in the data for the younger group.
That gets at another point, confidence in conclusions we could try to draw from the data. It's defined by the quality of the data.
However my question was more in identifying why younger people might have a higher hazard ratio then older people. The answer I am thinking of is very certainly not the only one, nor the only thing worth considering from the data. I was curious what people might come up with.
Let's see. Ignoring the error, I would tend to say this may be connected to the first figure and the genuine differences between the two age categories (that are not really visible on the third figure). But I may be wrong here :)
Young Vs. Old Hazard Ratio:
Liking the return of the Hazard Ratio. Its very cool that young people with over 200 mg/dL FSG have a higher hazard ratio than old people with the same FSG.
The reason why is very simple. Young people have been infected with a slowvirus by the lizard people at the center of the flat earth (through fluorine our our tap water obviously) that saps their life force making them more susceptible to high FSG levels.
Now here is the correct answer. Thank you for finally acknowledging the lizard people. But tell me, were they infected with that virus through mandatory vaccination???!!! #conspiracy
Young Vs. Old Hazard Ratio -
Age related increase in fasting blood glucose tapers off substantially so naturally the hazard ratio should plateau with respect to that
also general thoughts -
diabetes is best solved by addressing insulin resistance - https://intensivedietarymanagement.com/failure-blood-glucose-paradigm/
The issue is that drug companies use this research as supporting evidence that you should medicate with low efficacy to "manage" it in the short term when in the long term you aren't helping yourself if you don't address the root problems inflating the numbers.
This is a good thought, but not why. Think about what a hazard ratio is a ratio of. What changes with age?
I guess the other thought would be if you are in the red young in life, so to speak, your long term risk is substantially higher...i.e early coronary heart disease/atherosclerosis?
This is basically the reason. Your risk of mortality is lower when you are younger so the denominator is small. Increased risk for the changing variable leads to a much bigger hazard ratio. When you get older your overall risk of mortality is much higher so the difference between the two is smaller, this a smaller hazard ratio.
So, that is the reason.....Is there anything like "difference in tolerance of body to high Blood Glucose level with increasing age", ..do young people have low tolerance to high blood glucose than the old people?.....that may also affect the hazard ratio....searched but could not found about it...
Younger people having a lower tolerance to higher glucose? It's a good question, would have to do a literature search to find if anything is available. We're that observed it may also contribute.
You can take me, but you cannot take my bunghole.... For I have no bunghole....
Well, Normoglycemia has been associated with lower relative mortality risk
when compared to other conditions for quite a long time.
If there was anything interesting in this study was the fact it was done on a Korean population. The relationship between the three factors (sex, age, ethnicity) is not totally established but Southeast Asian populations have a lower tolerance to changes in glycemia at younger ages. Generalizing is quite complex without being precise.
Yes, the evidence of increased risk for diabetes with age is fairly well shown by data, however the relationship between mortality and diabetes at older age indeed not yet we'll supported.
Interesting, any thoughts or knowledge from research as to why this might be?
Generalizing is never precise.
Well, as I see it In mathematics generalizing is exact and in physics, precision allows generalization, as it deals with measurements. Of course, I can be wrong.
About Southeast Asian populations. On average, is due to low muscle mass and higher abdominal fat. This leads to insulin resistance more easily.
The Ethno-phenotypical traits are thought to have been selected for cold climates where fat based diets are preferred.
http://asiandiabetesprevention.org/what-is-diabetes/why-are-asians-higher-risk
I think it would be interesting to know what foods are allowed and forbidden to diabetics.
Regarding Food, there is something called Glycemic Index(GI). It measures how quickly blood sugar rises after the consumption of food ( ideally after 2 hours of consumption). Accordingly, the food is categorized into
A GI of 100 is considered standard.
A food with high GI ( white bread ,corn flakes etc) raises the blood sugar quickly. So, they are not advised to the diabetes patient with high blood sugar. But they are considered useful in case of the hypoglycemic patient.
Low GI food are: peaches, strawberries, mangos,mushrooms, beans ,wheat, millet, oat, rye etc. They are considered comparatevely good for diabetes patient.
Further reading:-
nice article @justtryme90
I agree with you @allesia It would be really helpful
Foods that are easily converted into simple sugars should be avoided. And things composed mostly of simple sugars shouldn't be consumed (soda). I don't think anything is forbidden, just the consequences of consuming too much sugar may very well be years taken from your lifespan.
Very good post, first time i know that. and good luck for @steemstem project. thanks @justtryme90
Thanks!
This comment has received a 0.52 % upvote from @drotto thanks to: @banjo.
What i find weird is that each year the number of diabetes patients is keeping on growing at an alarming rate, despite all types of precautions being taken by everyone!
Look at our elders/grand parents, they were living such healthy life and live long without any of these diseases.
It is sure that the food we are eating, even the one we think are organic-healthy are infact not , we are all being lied.
Well the population is really very big, and to cater for everyone, it is obvious that practically all foods are being cloned without our knowledge.
The best way out is to grow your own, but how many can..
Thanks for such a nice topic @justtryme90
@progressivechef
Keep sharing such content.
I don't think it has anything to do with us being 'lied' to. People are living longer in general and as such we see more of these chronic illnesses. Compound that with the increasingly sedentary lifestyle lived by many and it seems almost expected that we would see the trends that we do.
Yes you are absolutely right here with the lifestyle of many, it's normal to see this trend keeps on growing!
And also i think in the past we did not have the technologies too to detect such diseases and many were dead without even knowing having it!
You're so creative!
You've got the X-factor!
This deserves recognition.
Diabetes is a very worldwide disease, the more days the patient is growing, and the disease is not familiar with age.
The disease is not familiar with age? What does that mean?
it mean diabetes can attack all ages, both adults, and oldster.
Indeed it can
This is really interesting. This is exactly what i wanted to do my project about thanks!
Thank you for reading! I am glad you got something out of it!
So high glucose levels which are often seen in overweight and obese people is a a good indicator of potential mortality? Who would have guessed :O Other than that, the study does have some gold nuggets.
Great analysis, keep pumping articles like that. :)
Trying to get back into writing again. More to follow. Thanks!