The normoglycaemic group with elevated iron markers did not show

The normoglycaemic group with elevated iron markers did not show increased mortality

risk in comparison to the reference group of normoglycaemic and normal iron marker levels. This may seem inconsistent with other data on the increased mortality risk due to elevated TS by itself. AZD9291 astrazeneca However, there is the potential that the effect of TS on mortality is modified by the presence of other variables.19 21 This effect has been shown in the past. Rather than being inconsistent with the TS alone and mortality findings, these new findings enhance our understanding of elevated iron markers and morbidity and mortality and allow us to consider the more complex, but real, situation of patients by considering multiple variables together rather than independently. This

study has several limitations. First, although we have a nationally representative, population-based cohort followed through the National Death Index, the biomarkers are measured only at baseline. There is the possibility that either the hyperglycaemia or elevated iron measures were identified and interventions were implemented to lower these biomarkers. If that were the case and a substantial number of individuals did drop their levels due to interventions thereby decreasing the potential mortality risk, the observed adjusted risk individuals elevated at baseline is even more concerning. Second, we were only able to follow these individuals for 12 years. It is possible that this time frame may have been too short to adequately see an effect for a biomarker like prediabetes. However, we did censor the first 3 years of mortality so that any deaths in that time frame would not be attributed to prediabetes. The model still found a substantial mortality risk for the prediabetes plus iron markers in this length of time. Third, we were unable to evaluate the relationship between being elevated Batimastat on both TS and serum ferritin with prediabetes on the risk of mortality.

We attempted such an analysis but the number of individuals in the group with prediabetes and elevation on both iron markers was small and the population estimates were deemed unreliable. In conclusion, this study representative of the population of the USA helps to clarify the current evidence on the mortality risk of prediabetes and provides further support for the role of elevated iron markers in health risk. Future screening and intervention programmes for prediabetes may benefit from additional strategies to recognise and treat iron elevations, particularly TS. Supplementary Material Author’s manuscript: Click here to view.(2.3M, pdf) Reviewer comments: Click here to view.

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