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Add-on proton pump inhibitor therapy improved glycemic markers in adults with type 2 diabetes, but did not change the risk of a diabetes incident, according to a meta-analysis published in the Journal of Clinical Endocrinology & Metabolism.
There is a higher prevalence of upper gastrointestinal symptoms in adults with diabetes, especially those with poor glycemic response. Kashif M. Munir, MD, Vice Chief and Associate Professor of Medicine in the Department of Endocrinology, Diabetes, and Nutrition at the University of Maryland School of Medicine, and colleagues wrote about the background of the study. Despite new evidence of the potential glucose-lowering effects of proton pump inhibitors (PPIs) in diabetes and a reduced risk of a diabetes incident in those without diabetes using PPI therapy, the effect of PPIs on these two populations remains unclear, they wrote.
Munir is Associate Director and Associate Professor of Medicine in the Department of Endocrinology, Diabetes, and Nutrition at the University of Maryland School of Medicine.
“PPIs are very common drugs and can have an impact on the incretin axis,” Munir told Healio. “Our meta-analysis shows that PPIs have a modest but statistically significant effect on improving glucose levels in patients with diabetes.”
Carol Chiung-Hui Peng
Munir and colleagues analyzed data from seven studies examining whether PPI therapy could improve glycemic response in adults with type 2 diabetes (n = 342) and from five studies examining whether PPIs increased the risk of developing diabetes in the general population (n = 244,439). . Studies compared HbA1c or fasting blood glucose in diabetics who were treated with and without PPI therapy in addition to standard therapy. The researchers used weighted mean intergroup differences or relative risks calculated using random effects models.
Compared to the standard therapy, the additional PPI therapy resulted in a significant decrease in HbA1c (weighted mean difference, -0.36%; 95% CI, -0.68 to -0.05) and fasting blood sugar (weighted mean difference, -10 mg / dL; 95% CI, -19.4 to -0.6).
Use of PPIs did not reduce the risk of a diabetes incident with a pooled RR of 1.1 (95% CI, 0.89-1.34).
In sensitivity analyzes with “leave-one-out”, the researchers show considerable heterogeneity and non-robustness between the studies. However, the results show the “therapeutic potential” of PPI therapy for diabetes, the researchers wrote.
“Proton pump inhibitor use is widespread and providers should be aware of their potential impact on glycemic control in patients with diabetes.” Carol Chiung-Hui Peng, MD, Resident in the internal medicine department on the midtown campus of the University of Maryland Medical Center in Baltimore, Healio said. “More data are needed to determine whether concomitant treatment of PPIs with other drugs [that] Incretin effects such as GLP-1 receptor agonists or DPP-IV inhibitors may have an additional glycemic benefit, as suggested by preclinical studies. “
For more informations:
Kashif M. Munir, MD, reachable at kmunir@som.umaryland.edu
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