Diabetes, insulin use and Helicobacter pylori eradication: a retrospective cohort study

Abstract

BackgroundDiabetic patients may have a higher risk of gastric cancer. However, whether they have a higher incidence of Helicobacter pylori (HP) eradication is not known. Furthermore, whether insulin use in patients with type 2 diabetes may be associated with a higher incidence of HP eradication has not been investigated.MethodsThis is a retrospective cohort study. The reimbursement databases from 1996 to 2005 of 1 million insurants of the National Health Insurance in Taiwan were retrieved. After excluding those aged <25 years, cases of gastric cancer, cases receiving HP eradication before 2005, patients with type 1 diabetes mellitus and those with unknown living region, the reimbursement data of a total of 601,441 insurants were analyzed. Diabetes status and insulin use in patients with type 2 diabetes before 2005 were the main exposures of interest and the first event of HP eradication in 2005 was the main outcome evaluated. HP eradication was defined as a combination use of proton pump inhibitor or H2 receptor blockers, plus clarithromycin or metronidazole, plus amoxicillin or tetracycline, with or without bismuth, in the same prescription for 7-14 days. The association between type 2 diabetes/insulin use and HP eradication was evaluated by logistic regression, considering the confounding effect of diabetes duration, comorbidities, medications and panendoscopic examination.ResultsIn 2005, there were 10,051 incident cases receiving HP eradication. HP eradication was significantly increased with age, male sex, diabetes status, insulin use, use of calcium channel blocker, panendoscopic examination, hypertension, dyslipidemia, chronic obstructive pulmonary disease, stroke, nephropathy, ischemic heart disease and peripheral arterial disease. Significant differences were also seen for occupation and living region. Medications including statin, fibrate, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and oral anti-diabetic agents were not associated with HP eradication. The adjusted odds ratios for diabetes, insulin use and use of calcium channel blocker was 1.133 (1.074, 1.195), 1.414 (1.228, 1.629) and 1.147 (1.074, 1.225), respectively.ConclusionsType 2 diabetes and insulin use in the diabetic patients are significantly associated with a higher incidence of HP eradication. Additionally, use of calcium channel blocker also shows a significant association with HP eradication.

Effect of Helicobacter pylori eradication on glycaemia control in patients with type 2 diabetes mellitus and comparison of two therapeutic regimens

“…In Tseng's study, [14] a significantly higher incidence of H. pylori eradication in patients with type 2DM and in insulin users was seen. The odds ratios were attenuated with increasing diabetes duration, probably due to the occurrence of other co-morbidities.…”

“…There have been controversial results in these studies but in a large, well-designed study of Xia et al, there was no difference of the seroprevalence of H. pylori infection between patients with DM and non-DM controls [5]. Tseng [14] showed a higher incidence of H. pylori eradication in patients with type 2 DM and in insulin users among the diabetic patients. Further, Polyzos [15] studied a potential association between H. pylori infection, metabolic syndrome and insulin resistance, but further studies are needed to strengthen this association and to clarify whether there is a causative link between them.…”

Metformin and lung cancer risk in patients with type 2 diabetes mellitus

“…History of HP infection was defined based on one of the following two criteria: 1) having received an HP eradication therapy (detailed previously [47] and defined in brief as a combination use of proton pump inhibitors or H2 receptor blockers, plus clarithromycin, metronidazole or levofloxacin, plus amoxicillin or tetracycline, with or without bismuth, in the same prescription order for 7-14 days); and/or 2) HP infection diagnosis (041.86).…”

Metformin and esophageal cancer risk in Taiwanese patients with type 2 diabetes mellitus

“…History of HP infection was defined based on one of the following two criteria: 1) having received an HP eradication therapy (detailed previously [36] and defined in brief as a combination use of proton pump inhibitors or H2 receptor blockers, plus clarithromycin, metronidazole or levofloxacin, plus amoxicillin or tetracycline, with or without bismuth, in the same prescription order for 7–14 days); and/or 2) HP infection diagnosis (041.86). The accuracy of disease diagnoses in the NHI database has been studied previously.…”