Exploring the impact of proton pump inhibitors on the risk of diabetes in patients with gastroenterologic disorders

• Main Authors: Yu-Ting Hsiao, 蕭羽婷
• Other Authors: 王莉萱
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/v3mbfa

碩士 === 臺北醫學大學 === 生技製藥企業經營管理產業碩士專班 === 102 === Background and objective Diabetes mellitus (DM) is an epidemic disease worldwide, the number of people with diabetes mellitus has more than doubled globally in the past three decades. In 2013, diabetes mellitus (DM) was the number five killer inTaiwan. Proton pump inhibitors (PPIs) are now widely used for the treatment of gastric acid-related diseases. It acts to block the hydrogen/potassium adenosine triphosphatase enzyme in the system ,and thereby resulting in increased blood gastrin concentration. Several studies have shown that PPIs are associated with better glycemic control in DM patients. In addition, gastrin induces β-cell neogenesis, and in vitro studies, this hormone increases the β-cells mass. There is limited clinical data regarding the PPIs effects on DM risk, especially among Asian population, and these studies did not provide a clear analysis of the effect of PPIs dose on DM risk reduction, we conducted a hypothesis-generating, retrospective study in Taiwan to assess the risk of DM development among Gastrointestinal Disease (GID) patients treated with PPIs. Methods The study included 338,098 GID patients identified from the Longitudinal Health Insurance Database, with at least three consecutive episodes of diagnosed GID between January 1, 2000 and December 31, 2006. Only patients who had not been diagnosed with DM and received PPIs before January 1, 2000 were included to ensure that only newly identified cases were included. We classified the GID patients into the following groups: patients who received PPIs (study group), patients who did not received PPIs (comparison group I)；and non-GID patients (comparison group II). SAS statistical program was used to identify and select patients in the study group who were then matched to two GID patients without PPIs (comparison group I) and each patient in comparison group I was matched to two non-gastrointestinal disease patients. Results We compared the DM risk between comparison group I and comparison group II, the adjusted hazard ratio was 1.27 (95% CI 1.19-1.36; p < 0.001) for GID patients without PPIs (comparison group I) compared with non-GID patients (comparison group II). In addition, the adjusted hazard ratio was 0.73 (95% CI 0.67-0.80; p < 0.001) for GID patient receiving PPIs (study group) compared with GID patient without PPIs (comparison group I). In addition, the effects of PPIs were shown to be significantly dose-dependent (P for trend < 0.001). Conclusions The results showed decrease DM risk in GID patients associated with use of PPIs and the association appears to be significantly dose-dependent. Further studies are warranted to determine if this association is causal and whether PPIs have the potential to be used clinically as new antidiabetic drugs and DM prevention agents.