The Relationship Between Type 2 Diabetes Mellitus and Proton Pump Inhibitor Failure in Patients With Gastroesophageal Reflux Disease

Abstract

Introduction: There have been a limited number of studies that evaluated risk factors for proton pump inhibitor (PPI) failure in patients with type 2diabetes mellitus (DM) and concomitant gastroesophageal reflux disease (GERD). The aim of the study was to determine the predictive risk factors for PPI failure among patients diagnosed with type 2 DM and GERD. Methods: Using a population-based study, 398 patients diagnosed with GERD who were treated with a PPI between 2004 and 2014 were included in the study. Patients were divided based on the presence of type 2 DM (diagnosed >1 year prior to enrollment into the study) and were further classified depending on their response to PPI therapy into PPI-responders and PPI-failure. PPI failure was defined as the need to treat with more than once daily PPI or the addition of other anti-reflux agents to ncontrol GERD-related symptoms. Results: A total of 398 patients with GERD were included in the study and of those 65 patients (16.3%) also had the diagnosis of type 2 DM. A total of 30 patients had failed PPI once daily. Between the DM and non DM group, 93 patients (23.4%) had failed PPI therapy and 305 (76.6%) had good response to PPI therapy. Most of the patients were females (61.5%) and mean age of the patients was 53.9 years (range 22-83). Poor diabetic control was measured by HgA1c, and shown to increase the risk of PPI failure by almost 50% (OR 1.47 95% CI 1.03-2.08, p=0.03). Also, in all GERD patients, PPI failure depended on female gender and depression. Males were half as likely to fail PPI therapy (OR 0.56 95% CI 0.34-0.93, p=0.03) and depression carried an odds ratio which was twice that of the normal population (OR 2.00 95% CI 1.19-3.36 p=0.01). Type II diabetes, duration of diabetes, and type of anti-diabetic medication prescribed were not statistically significantly associated with PPI failure.Table 1: Risk factors with P <0.05Conclusion: In GERD patients, female gender and depression were predictive factors of PPI failure. In GERD patients with type 2 DM, poor control of DM as measured by HgA1c was predictive of PPI failure.