Habitual glucosamine use and mortality risk among individuals with type 2 diabetes: A prospective study
Glucosamine is a commonly used supplement, but concerns persist regarding its use in individuals with diabetes. This study aimed to examine the association of habitual glucosamine use with risks of all-cause and cause-specific mortality among individuals with type 2 diabetes, and to explore the potential mediating role of blood biomarkers in these associations. We included 19125 participants with type 2 diabetes from the UK Biobank who provided self-reported information on glucosamine use at baseline. Cox proportional hazards models were used to estimate the associations, with results presented as hazard ratios (HRs) and its 95% confidence intervals (CIs). Mediation analyses were conducted to estimate the extent to which selected blood biomarkers may be involved in these associations. Over a median follow-up of 13.5 years, 3045 deaths were recorded, including 1095 cancer deaths and 741 cardiovascular deaths. In multivariable-adjusted analyses, glucosamine use was associated with lower risks of all-cause, cancer, and cardiovascular mortality, with HRs (95% CIs) of 0.77 (0.68, 0.86), 0.82 (0.68, 0.99), and 0.73 (0.57, 0.94), respectively. These associations were generally consistent across several subgroups, including diabetes-related factors, demographic characteristics, lifestyle, medication use and health conditions. Furthermore, blood biomarkers (such as cystatin C, alkaline phosphatase, and C-reactive protein) explained 13.61% (95% CI, 8.26, 34.14) of the association between glucosamine use and all-cause mortality. Our findings suggest that glucosamine use was inversely associated with mortality in individuals with type 2 diabetes, with several blood biomarkers partly explaining this association; however, clinical trials are needed to confirm these findings.