Long-term increase in fasting blood glucose is associated with increased risk of sudden cardiac arrest

BACKGROUND: Diabetes mellitus (DM) is associated with various cardiovascular complications, including sudden cardiac arrest (SCA). Furthermore, the severity of DM, as assessed by fasting blood glucose (FBG), is associated with the risk of SCA. However, whether long-term changes in FBG influence on SCA risk remains to be determined. METHODS: This study used sequential nationwide health screening data from 2009 and 2011. FBG was measured at each health screening, and ΔFBG was calculated as FBG in 2011–FBG in 2009. RESULTS: Overall, 2,801,153 people were analyzed, and the mean follow-up duration was 6.33 years. Compared with the euglycemic group (− 20 ≤ ΔFBG < 20), the 20 ≤ ΔFBG < 40, 40 ≤ ΔFBG < 100, and ΔFBG ≥ 100 groups had increased SCA risks of 25% (adjusted hazard ratio [HR] = 1.25; 95% confidence interval [CI] 1.16–1.35; p < 0.001), 66% (adjusted HR = 1.66; 95% CI 1.49–1.86; p < 0.001), and 2.9-fold (adjusted HR = 2.85; 95% CI 2.37–3.44; p < 0.001), respectively. The association between ΔFBG and SCA was maintained in people with DM but not in people without DM. However, sex, age, blood pressure, and presence of heart failure did not affect the association between ΔFBG and SCA. A decrease in ΔFBG over time was not associated with reduced risk of SCA: the adjusted HR was 1.11 (95% CI 0.98–1.27; p = 0.113) for the ΔFBG < –40 group and 1.12 (95% CI 1.03–1.22; p = 0.009) for the − 40 ≤ ∆FBG < − 20 group. CONCLUSIONS: A long-term increase in ΔFBG can be associated with increased risk of SCA in people with DM. However, a long-term decrease in ΔFBG was not associated with reduced risk of SCA. Actions to prevent increase in FBG can have significant effects on public health in terms of SCA prevention. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12933-023-01764-0.