Papers p 15

Although diabetes is a strong risk factor for coronary heart disease, the association between glycaemia within the “normal range” and coronary heart disease has been somewhat controversial.1 A 1979 collaborative report from 15 countries found the risk ratio in the highest versus the lowest centile of glycaemia to range from 0.34 to 6.07 in men from Finland, Denmark, France, the United Kingdom, and the United States.2 In other cohort studies, including Whitehall3 and Framingham,4 there appeared to be a threshold effect, with risk observed only at glucose levels approaching or including current diagnostic criteria for diabetes. There are several possible reasons for these contradictory results, including: the failure to exclude people with diabetes from the cohorts, compatible with a threshold effect; the multifactorial aetiology of coronary heart disease, compatible with confounding; or the large intra-individual variation in glucose (especially postchallenge glucose) values, compatible with misclassification bias.

Glycosylated haemoglobin, an integrated estimate of glucose over the preceding 6-12 weeks, …