Effect of Helicobacter pylori eradication on insulin resistance among prediabetic patients: A pilot study and single-blind randomized controlled clinical trial

Abstract

Background:Type II diabetes mellitus (T2DM) is the prevalent type of diabetes in the world. Prediabetic patients are the most probable group to get diabetes. Several studies have mentioned the role of inflammation in the incidence of diabetes. The origin of inflammation can be infection such as Helicobacter pylori (HP) infection. This study was designed to explore the effect of HP eradication on insulin resistance.Materials and Methods:This single-blind randomized controlled clinical trial was conducted in 2014-2015. The sample size consisted of 49 individuals who were in prediabetes stage with HP infection. Patients with positive stool antigen were allocated randomly into two groups. The treatment group took medication to eradicate HP infection by the routine method of four-drug eradication. However, placebo capsules and tablets were given to the patients in the placebo group. Then fasting plasma glucose (FPG), fasting plasma insulin (FPI), and quantitative C-reactive protein (CRP) levels were measured and homeostatic model assessment of insulin resistance (HOMA-IR), homeostatic model assessment of beta-cell function (HOMA-B), Matsuda index, insulinogenic index, and disposition index were calculated.Results:Results of this study showed that FPI and HOMA-IR increased significantly (P value of FPI = 0.023 and P value of HOMA-IR = 0.019) after HP eradication in the treatment group. On the other hand, comparison of differences at the baseline and after 6 weeks in FPG (P value = 0.045), FPI (P value = 0.013), and HOMA-B (P value = 0.038) revealed significant differences between the placebo group and treatment group.Conclusion:Results showed that HP eradication by a 2-week antibiotic medication did not decrease insulin resistance and even increased FPI and insulin resistance indices. So HP eradication among prediabetic patients is not recommended for the decrease of insulin resistance and postponement of the development of diabetes mellitus.

H. pylori infection and extra-gastroduodenal diseases

“…Wada et al also found that successful eradication of H. pylori could not improve glucose control of DM in Japanese patients [ 55 ]. Furthermore, a recent randomized controlled trial involving 49 H. pylori -infected subjects in a prediabetes stage showed that H. pylori eradication resulted in an increased Homeostatic model assessment of insulin resistance (HOMA-IR) [ 56 ].…”

Methylglyoxal and insulin resistance in berberine-treated type 2 diabetic patients

“…Chronic rise in blood glucose levels is termed as the hyperglycemia. [ 1 2 ] Chronic hyperglycemia associated with oxidative stress in DM produces a variety of glucose-derived toxic agents called the “α-oxoaldehydes.” The α-oxoaldehydes react with N-terminal amino group of proteins to form the advanced glycation end products (AGEs). [ 3 ] Methylglyoxal (MGO) is one of the α-oxoaldehydes which interferes with cell functions, insulin signaling, and β-cell functions.…”

Osmotic therapies added to antibiotics for acute bacterial meningitis

“…All trial authors designed control agents that had a similar taste and texture to glycerol for concealment purposes, and whether any of the substances used exerted an independent osmotic action is untested. However, the higher mortality reported by Ajdukiewicz 2011 in the glycerol group suggests that glycerol had an action beyond any osmotic effect exerted by the dextrose placebo, particularly as the glycerol was diluted in dextrose for some participants (Brouwer 2011). …”

“…We were unable to control for this effect in the analysis, which may have introduced further heterogeneity (Brouwer 2011; Saez-Llorens 2007). Prolonged use of osmotic agents, such as the four-day courses of glycerol used in Ajdukiewicz 2011, have been suggested to be harmful.…”