Guandoing, China—
A controversial analysis from Chinese researchers suggests that regular use of common drugs to reduce stomach acid can increase risk of developing type 2 diabetes.

A report in the journal Gut Microbiota examines routine use of proton pump inhibitors and risk of type 2 diabetes, taking into account results from three prospective cohort studies.
 
“The association between the regular use of proton pump inhibitors (PPIs) and the risk of type 2 diabetes remains unclear, although a recent randomized controlled trial showed a trend towards increased risk,” according to Sun Yat-Sen University–led researchers, who said their study “was undertaken to evaluate the regular use of PPIs and risk of type 2 diabetes.”

The study notes that PPIs clearly have a major effect on gut microbiome, which could increase the risk of type 2 diabetes.

The prospective analysis involved 204,689 participants free of diabetes in the Nurses’ Health Study (NHS), NHS II, and Health Professionals Follow-up Study (HPFS). Researchers confirmed type 2 diabetes using American Diabetes Association (ADA) diagnostic criteria. 

Authors of the analysis evaluated hazard ratios (HRs), adjusting for demographic factors, lifestyle habits, the presence of comorbidities, use of other medications, and clinical indications.

Overall, 10,105 incident cases of diabetes over 2,127,471 person-years of follow-up were documented. Results indicate that regular PPI users had a 24% higher risk of diabetes than nonusers (HR 1.24; 95% CI 1.17-1.31). 

The authors suggest that risk of diabetes increased with duration of PPI use, noting “Fully adjusted HRs were 1.05 (95% CI 0.93 to 1.19) for participants who used PPIs for >0–2 years and 1.26 (95% CI 1.18 to 1.35) for participants who used PPIs for >2 years compared with non-users.”

Pointing out that regular use of PPIs was associated with a higher risk of type 2 diabetes and that the risk increased with longer duration of use, the researchers write, “Physicians should therefore exercise caution when prescribing PPIs, particularly for long-term use.”

They also advise that screening for abnormal blood glucose and type 2 diabetes might be required for regular PPI users, particularly for high-risk populations.

Past research has linked long-term use of PPIs to health problems such as bone fracture and enteric infections, according to background information in the report.

The authors recommend that future evaluations, including well-designed cohort studies, randomized controlled trials, and meta-analyses, be conducted to confirm their conclusions. They also urge more basic scientific research to investigate the underlying mechanisms that could be behind such a link.

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