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

BMC Gastroenterology

Chin-Hsiao Tseng¹ 

[1] Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan

关键词: Taiwan;    National Health Insurance;    Gastric cancer;    Insulin;    Helicobacter pylori;    Diabetes;   

Others  :  1113081
DOI  :  10.1186/1471-230X-12-46

 received in 2011-10-14, accepted in 2012-05-09,  发布年份 2012

【 摘 要 】

Background

Diabetic 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.

Methods

This 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.

Results

In 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.

Conclusions

Type 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.

【 授权许可】

   
2012 Tseng; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Tseng CH: Diabetes conveys a higher risk of gastric cancer mortality despite an age-standardised decreasing trend in the general population in Taiwan. Gut 2011, 60:774-779.
• [2]Wong BC, Lam SK, Wong WM, Chen JS, Zheng TT, Feng RE, Lai KC, Hu WH, Yuen ST, Leung SY, Fong DY, Ho J, Ching CK, Chen JS, China Gastric Cancer Study Group: Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA 2004, 291:187-194.
• [3]de Luis DA, de la Calle H, Roy G, de Argila CM, Valdezate S, Canton R, Boixeda D: Helicobacter pylori infection and insulin-dependent diabetes mellitus. Diabetes Res Clin Pract 1998, 39:143-146.
• [4]Dore MP, Bilotta M, Malaty HM, Pacifico A, Maioli M, Graham DY, Realdi G: Diabetes mellitus and Helicobacter pylori infection. Nutrition 2000, 16:407-410.
• [5]Selinger C, Robinson A: Helicobacter pylori eradication in diabetic patients: still far off the treatment targets. South Med J 2010, 103:975-976.
• [6]Sargýn M, Uygur-Bayramicli O, Sargýn H, Orbay E, Yavuzer D, Yayla A: Type 2 diabetes mellitus affects eradication rate of Helicobacter pylori. World J Gastroenterol 2003, 9:1126-1128.
• [7]Demir M, Gokturk HS, Ozturk NA, Serin E, Yilmaz U: Efficacy of two different Helicobacter pylori eradication regimens in patients with type 2 diabetes and the effect of Helicobacter pylori eradication on dyspeptic symptoms in patients with diabetes: a randomized controlled study. Am J Med Sci 2009, 338:459-464.
• [8]Ojetti V, Migneco A, Nista EC, Gasbarrini G, Gasbarrini A, Pitocco D, Ghirlanda G: H pylori re-infection in type 1 diabetes: a 5 years follow-up. Dig Liver Dis 2007, 39:286-287.
• [9]Ojetti V, Pitocco D, Bartolozzi F, Danese S, Migneco A, Lupascu A, Pola P, Ghirlanda G, Gasbarrini G, Gasbarrini A: High rate of helicobacter pylori re-infection in patients affected by type 1 diabetes. Diabetes Care 2002, 25:1485.
• [10]Devrajani BR, Shah SZ, Soomro AA, Devrajani T: Type 2 diabetes mellitus: A risk factor for Helicobacter pylori infection: A hospital based case-control study. Int J Diabetes Dev Ctries 2010, 30:22-26.
• [11]Bener A, Micallef R, Afifi M, Derbala M, Al-Mulla HM, Usmani MA: Association between type 2 diabetes mellitus and Helicobacter pylori infection. Turk J Gastroenterol 2007, 18:225-229.
• [12]Demir M, Gokturk HS, Ozturk NA, Kulaksizoglu M, Serin E, Yilmaz U: Helicobacter pylori prevalence in diabetes mellitus patients with dyspeptic symptoms and its relationship to glycemic control and late complications. Dig Dis Sci 2008, 53:2646-2649.
• [13]Department of Health, Taiwan [http:/ / www.doh.gov.tw/ CHT2006/ DM/ DM2_2.aspx?now_fod_list_no=10383&cl ass_no=440&level_no=4 ] webcite (accessed March 21, 2012)
• [14]Wu CY, Kuo KN, Wu MS, Chen YJ, Wang CB, Lin JT: Early Helicobacter pylori eradication decreases risk of gastric cancer in patients with peptic ulcer disease. Gastroenterology 2009, 137:1641-1648. e1-2
• [15]Friedenberg FK, Hanlon A, Vanar V, Nehemia D, Mekapati J, Nelson DB, Richter JE: Trends in gastroesophageal reflux disease as measured by the National Ambulatory Medical Care Survey. Dig Dis Sci 2010, 55:1911-1917.
• [16]Beil W, Wagner S, Piller M, Heim HK, Sewing KF: Stimulation of pepsinogen release from chief cells by Helicobacter pylori: evidence for a role of calcium and calmodulin. Microb Pathog 1998, 25:181-187.
• [17]Kang JM, Kim N, Shin CM, Lee HS, Lee DH, Jung HC, Song IS: Predictive factors for improvement of atrophic gastritis and intestinal metaplasia after helicobacter pylori eradication: a three-year follow-up study in Korea. Helicobacter 2012, 17:86-95.
• [18]Kodama M, Murakami K, Okimoto T, Abe T, Nakagawa Y, Mizukami K, Uchida M, Inoue K, Fujioka T: Helicobacter pylori eradication improves gastric atrophy and intestinal metaplasia in long-term observation. Digestion 2012, 85:126-130.
• [19]Kodama M, Murakami K, Okimoto T, Sato R, Uchida M, Abe T, Shiota S, Nakagawa Y, Mizukami K, Fujioka T: Ten-year prospective follow-up of histological changes at five points on the gastric mucosa as recommended by the updated Sydney system after Helicobacter pylori eradication. J Gastroenterol 2012, 47:394-403.
• [20]Lin JT, Wang JT, Wang TH, Wu MS, Lee TK, Chen CJ: Helicobacter pylori infection in a randomly selected population, healthy volunteers, and patients with gastric ulcer and gastric adenocarcinoma. A seroprevalence study in Taiwan. Scand J Gastroenterol 1993, 28:1067-1072.
• [21]Gale EA: A missing link in the hygiene hypothesis? Diabetologia 2002, 45:588-594.
• [22]Aguemon BD, Struelens MJ, Massougbodji A, Ouendo EM: Prevalence and risk-factors for Helicobacter pylori infection in urban and rural Beninese populations. Clin Microbiol Infect 2005, 11:611-617.
• [23]Hoang TT, Bengtsson C, Phung DC, Sörberg M, Granström M: Seroprevalence of Helicobacter pylori infection in urban and rural Vietnam. Clin Diagn Lab Immunol 2005, 12:81-85.