Original Article
Type 2 Diabetes Mellitus and Helicobacter pylori Eradication in a Clinical Population
Abstract
Objectives: Eradication of Helicobacter pylori reduces the risk of gastric cancer (GC). Individuals with type 2 diabetes mellitus (T2DM) are known to be at increased risk for GC. In a cohort of H. pylori-positive individuals, we assessed whether those with T2DM were at risk of persistent infection following H. pylori treatment compared with individuals without T2DM.Methods: A random subset of all individuals diagnosed as having H. pylori without intestinal metaplasia at endoscopy from 2015 to 2019 were stratified evenly by race (Black and White). After excluding those with T1DM and those without eradication testing after H. pylori treatment, logistic regression analysis was used to determine the association of T2DM with the risk of persistent H. pylori infection following treatment.
Results: In 138 patients, H. pylori eradication rates did not differ between the 27% of individuals with T2DM compared to those without (81.1% vs 81.2%). After adjusting for age, race, and insurance status, we found no significant increased risk of persistent H. pylori infection for individuals with T2DM (odds ratio 1.40; 95% confidence interval 0.49–3.99).
Conclusions: H. pylori eradication rates do not differ by T2DM status, providing support for clinical trials of H. pylori eradication to reduce GC incidence among high-risk populations in the United States, such as individuals with T2DM.
Posted in: Endocrinology, Diabetes, and Metabolism36
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References
1. Brown LM. Helicobacter pylori: epidemiology and routes of transmission. Epidemiol Rev 2000;22:283–297.
2. Hooi JKY, Lai WY, Ng WK, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology 2017;153: 420–429.
3. Li D, Jiang SF, Lei NY, et al. Effect of Helicobacter pylori eradication therapy on the incidence of noncardia gastric adenocarcinoma in a large diverse population in the United States. Gastroenterology 2023;165:391–401.e2.
4. Argueta EA, Moss SF. The prevention of gastric cancer by Helicobacter pylori eradication. Curr Opin Gastroenterol 2021;37:625–30.
5. Mokhtare M, Mirfakhraee H, Arshad M, et al. The effects of Helicobacter pylori eradication on modification of metabolic syndrome parameters in patients with functional dyspepsia. Diabetes Metab Syndr 2017;11(Suppl 2): S1031–S1035.
6. Gen R, Demir M, Ataseven H. Effect of Helicobacter pylori eradication on insulin resistance, serum lipids and low-grade inflammation. South Med J 2010;103:190–196.
7. Bajaj S, Rekwal L, Misra SP, et al. Association of Helicobacter pylori infection with type 2 diabetes. Indian J Endocrinol Metab 2014;18:694–699.
8. Guo J, Liu C, Pan J, et al. Relationship between diabetes and risk of gastric cancer: a systematic review and meta-analysis of cohort studies. Diabetes Res Clin Pract 2022;187:109866.
9. Sargýn M, Uygur-Bayramicli O, Sargýn H, et al. Type 2 diabetes mellitus affects eradication rate of Helicobacter pylori. World J Gastroenterol 2003; 9:1126–1128.
10. Demir M, Gokturk HS, Ozturk NA, et al. Clarithromycin resistance and efficacy of clarithromycin-containing triple eradication therapy for Helicobacter pylori infection in type 2 diabetes mellitus patients. South Med J 2009; 102:1116–1120.
.
11. Kim WS, Choi Y, Kim N, et al. Long-term effect of the eradication of Helicobacter pylori on the hemoglobin A1c in type 2 diabetes or prediabetes patients. Korean J Intern Med 2022;37:579–590.
12. Chey WD, Leontiadis GI, Howden CW, et al. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol 2017;112:212–239.
13. Peron EP, Ogbonna KC, Donohoe KL. Antidiabetic medications and polypharmacy. Clin Geriatr Med 2015;31:17–27.
14. Murakami TT, Scranton RA, Brown HE, et al. Management of Helicobacter pylori in the United States: results from a national survey of gastroenterology physicians. Prev Med 2017;100:216–222.
15. Savoldi A, Carrara E, Graham DY, et al. Prevalence of antibiotic resistance in Helicobacter pylori: a systematic review and meta-analysis in World Health Organization regions. Gastroenterology 2018;155:1372–1382.e17.
16. Fuccio L, Zagari RM, Eusebi LH, et al. Meta-analysis: can Helicobacter pylori eradication treatment reduce the risk for gastric cancer? Ann Intern Med 2009;151:121–128.
17. Liebl A, Khunti K, Orozco-Beltran D, et al. Health economic evaluation of type 2 diabetes mellitus: a clinical practice focused review. Clin Med Insights Endocrinol Diabetes 2015;8:13–19.
18. Martín-Núñez GM, Cornejo-Pareja I, Coin-Aragüez L, et al. H. pylori eradication with antibiotic treatment causes changes in glucose homeostasis related to modifications in the gut microbiota. PLoS One 2019;14:e0213548.
19. Laine L, Fennerty MB, Osato M, et al. Esomeprazole-based Helicobacter pylori eradication therapy and the effect of antibiotic resistance: results of three US multicenter, double-blind trials. Am J Gastroenterol 2000;95:3393–3398.
20. Mégraud F. H. pylori antibiotic resistance: prevalence, importance, and advances in testing. Gut 2004;53:1374–1384.
21. Tshibangu-Kabamba E, Yamaoka Y. Helicobacter pylori infection and antibiotic resistance - from biology to clinical implications. Nat Rev Gastroenterol Hepatol 2021;18:613–629.
