HbA1c predicts mortality in peripheral artery disease

Iren Drange Hjellestad has studied the prevalence of type 2 diabetes among patients surgically treated for peripheral artery disease, and their risk of dying within the next ten years.


  1. HbA1c and oral glucose tolerance test does not identify diabetes mellitus in the same patients with peripheral artery disease.
  2. HbA1c predicts mortality in patients with peripheral artery disease and in patients with abdominal aortic aneuriysms.
  3. One of three patients with peripheral artery disease have diabetes without knowing.


Thesis: Biomarkers for Diabetes Mellitus in advanced Peripheral Arterial Disease: Diagnostic performance and outcome prediction of HbA1c, fasting plasma glucose and the oral glucose tolerance test.
Candidate: Iren Drange Hjellestad
Time: May 14, 2019 at 11:15
Place: Haukeland University Hospital: Stort auditorium
Link to university website (in Norwegian)


(1) More patients with peripheral artery disease fulfill the criteria for diabetes when HbA1c is measured, compared to the oral glucose toleranse test. The two tests identified diabetes in the same two individuals in less than half of the cases.

345 patients undergoing vascular surgery for peripheral artery disease were included in the study. The prevalence of diabetes was 14.6 % with HbA1c, and 12 % with and oral glucose tolerance test. There was a significant correlation between the oral glucose tolerance test and reduced renal function.

(2) Persons with diabetes are at increased risk of dying following surgery for an abdominal aortic aneurysm. Moreover, one of three patients with high HbA1c were unaware of their diabetes before the surgical procedure.

The study includes 66 patients, of which 25 % had diabetes according to HbA1c levels. 43 % of the patients died within six years follow-up, and the risk was increased by several-fold in the patients with diabetes. The oral glucose tolerance test, on the other hand, did not predict risk of death.

(3) HbA1c also links to early death in patients with peripheral artery disease in general. Hjellestad and co-workers followed 273 patients for nine years, and 40 % died. The risk was increased by more than 50 % in patients with HbA1c-defined diabetes, although not statistically significant in the fully adjusted model. Oral glucose tolerance was not associated with long-term mortality.


(1) Hjellestad, I. D., Astor, M. C., Nilsen, R. M., Søfteland, E., & Jonung, T. (2013). HbA1c versus oral glucose tolerance test as a method to diagnose diabetes mellitus in vascular surgery patients. Cardiovascular diabetology12(1), 79.

(2) Hjellestad, I. D., Søfteland, E., Nilsen, R. M., Husebye, E. S., & Jonung, T. (2016). Abdominal aortic aneurysms–glycaemic status and mortalityJournal of Diabetes and its Complications30(3), 438-443.

(3) Hjellestad, I. D., Søfteland, E., Husebye, E. S., & Jonung, T. (2019). HbA1c predicts long‐term postoperative mortality in patients with unknown glycemic status at admission for vascular surgery: An exploratory studyJournal of diabetes11(6), 466-476.

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