Effect of Long-Term Proton Pump Inhibitor Use on Glycemic Control in Patients with Type Two Diabetes Mellitus.

Amy Trang,Jordan Bushman,Alexandra Halalau,Claudia Cardoso

doi:10.1155/2021/5578265

Abstract

There have been conflicting results regarding the effect of proton pump inhibitors (PPIs) as an adjunctive therapy to oral antidiabetic medication (OAM) in those with type 2 diabetes (T2DM). PPIs increase gastrin levels, causing a rise in insulin. No studies have evaluated the duration of PPI therapy and its effect on glycemic control. Medical records across 8 hospitals between 2007 and 2016 were reviewed for 14,602 patients with T2DM (not on insulin therapy) taking PPIs. Values of HbA1c (baseline, follow-up, and the difference between the two) in those prescribed with PPIs and years of therapy were compared to HbA1c values of those who had no record of PPI use. Baseline and follow-up HbA1c for patients on PPIs were 6.8 and 7.0, respectively, compared to 7.1 and 7.2 in their untreated counterparts (p < 0.001 in both comparisons). For both groups, an increase in baseline HbA1c was seen with time. Those on PPI had an increase in HbA1c of 0.16 compared to 0.08 in those not prescribed PPI. Our results show no relationship between the length of PPI therapy and HbA1c reduction.

Highlights

Proton pump inhibitors (PPIs) are commonly prescribed in the United States, with a rise in patients using long-term therapy [1]
Some risks associated with chronic PPI therapy include dementia, chronic kidney disease (CKD), myocardial infarction (MI), fractures, and increased mortality [3]
We hypothesized that patients taking PPIs and oral antidiabetic medication (OAM) would have lower HbA1c values when compared to patients taking OAM alone

Summary

Introduction

Proton pump inhibitors (PPIs) are commonly prescribed in the United States, with a rise in patients using long-term therapy [1]. The proposed mechanism by which PPIs improve HbA1c is by increasing serum gastrin which stimulates beta-cell neogenesis and causes an incretin-like effect, raising serum insulin [4]. There is conflicting evidence in the association between chronic PPI use and glycemic control. Two retrospective studies and one randomized control trial found an association between lower HbA1c levels while on PPI therapy [4,5,6]. We investigated whether there is a time-dependent relationship between PPI exposure and improvement in glycemic control in T2DM patients. We hypothesized that patients taking PPIs and oral antidiabetic medication (OAM) would have lower HbA1c values when compared to patients taking OAM alone. We hypothesized that the longer the duration of PPI therapy, the lower the levels of HbA1c

Design and Methods

Results

Findings

Discussion