Introduction: Diabetes prevalence in Greenland is high and increasing. Diabetes can be diagnosed by different criteria; currently HbA1c levels ≥ 48 mmol/mol, fasting plasma glucose (FPG) ≥ 7.0 mmol/l and/or two-hour plasma glucose (2hPG) ≥ 11.1 mmol/l after an oral glucose tolerance test (OGTT). We compared the risk of cardiovascular disease (CVD) by different diagnostic criteria, in the Greenland Inuit. Methods: Participants included in the population-based Inuit Health in Transition (IHIT) study in Greenland (2005-2010), had HbA1c, FPG and 2hPG levels measured at entry. We followed participants in the Danish and Greenlandic health registers for a composite endpoint of non-fatal and fatal CVD until 31/12-2017. Participants with known diabetes (n=77) and previous CVD (n=140), were excluded. We compared incidence rates for different diagnostic criteria, adjusted for various clinical and sociodemographic confounders in separate Poisson regressions, using multiple imputations for missing data and split follow-up into 1-year age-bands to account for a non-constant effect of age.

Results: We included 2,898 adult participants, with 246 CVD events and 366 deaths during follow-up. In the crude analyses, incidence rate ratios (IRR) of CVD were highest among participants diagnosed by HbA1c (IRR:2.69; 95%CI (1.66-4.34)), followed by participants diagnosed by FPG (2.04 (1.27-3.27)), and both FPG and 2hPG (1.96 (1.31-2.94)), compared with normoglycemia. The IRR for all three diagnostic criteria were attenuated after confounder adjustment (HbA1c 1.14 (0.70-1.88); FPG: 0.81 (0.50-1.30); FPG and 2hPG: 0.78 (0.51-1.18)).

Conclusions: IRR of CVD were highest among participants diagnosed by HbA1c in the crude analyses. None of the diagnostic criteria were associated with CVD after adjustment, especially for age. Future studies will investigate other diabetes related complications, competing risks from death, and interactions with genetic variants in the Greenland population.


S. Byberg: None. M. Tvermosegaard: None. L. Díaz: None. N.K. Senftleber: None. C.V.L. Larsen: None. P.F. Rønn: Research Support; Self; Amgen, Danish Diabetes Academy. Stock/Shareholder; Spouse/Partner; Novo Nordisk A/S. P. Bjerregaard: None. M.L. Pedersen: None. M.E. Jørgensen: Research Support; Self; Amgen, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi-Aventis. Stock/Shareholder; Self; Novo Nordisk A/S.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at