Eun Ju Cho

Background There exists a paucity of data regarding whether gamma‐glutamyl transferase is associated with disease‐specific mortality in patients with type 2 diabetes mellitus. This study aimed to investigate the association of serum gamma‐glutamyl transferase levels with all‐cause and disease‐specific mortality in patients with diabetes mellitus using a Korean nationwide health‐screening database. Methods A total of 9 687 066 patients without viral hepatitis or liver cirrhosis who underwent health examination in 2009 were included. These patients were divided into four groups according to sex‐specific quartiles of serum gamma‐glutamyl transferase levels. Results During a median follow‐up period of 8.1 years, 222 242 deaths were identified. The all‐cause mortality rate increased as the serum gamma‐glutamyl transferase levels became higher (highest quartile vs lowest quartile: hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.55–1.59; p for trend <.001). Similar trends were observed for cardiovascular disease (HR, 1.57; 95% CI, 1.53–1.62), ischemic heart disease (HR, 1.40; 95% CI, 1.33–1.48), and stroke (HR, 1.72; 95% CI, 1.60–1.85) in the highest quartile, as compared with the lowest quartile ( p for trend <.001). As the gamma‐glutamyl transferase quartiles became higher, mortality rates related to cancer (HR, 1.56; 95% CI, 1.52–1.60), liver disease (HR, 9.42; 95% CI, 8.81–10.07), respiratory disease (HR, 1.55; 95% CI, 1.49–1.62), and infectious disease (HR, 1.73; 95% CI, 1.59–1.87) also increased in the highest quartile, compared with the lowest quartile ( p for trend <.001). Conclusions Serum gamma‐glutamyl transferase levels may be useful for the risk assessment of all‐cause and disease‐specific mortality among patients with type 2 diabetes mellitus. image