Results from a study published in the Journal of Clinical Endocrinology and Metabolism suggest that some OTC agents, such as the proton pump inhibitors (PPIs) used to treat heartburn and gastric ulcers, may aid diabetics in lowering blood glucose levels. While the study suggests that PPIs are safe in patients with diabetes, the experts do not recommend individuals with diabetes begin taking them improve their blood sugar levels.

Peng et al conducted a meta-analysis to assess the impact of PPI therapy on glycemic control among individuals with diabetes and the risk of diabetes among those without diabetes. They conducted searches from PubMed, Embase, Scopus, and from inception to November 21, 2020. The analysis included studies comparing glycosylated hemoglobin (HbA1c) or fasting blood glucose (FBG) among individuals with diabetes treated with and without PPI therapy as an add-on to standard therapy. Studies assessing the risk of incident diabetes among individuals taking PPIs were evaluated.

The researchers conducted dual independent review, data extraction, and quality assessment and weighted average differences between groups or relative risks were imputed using random-effects models. They included seven studies (n = 342) for glycemic control and five studies (n = 244,439) for risk of incident diabetes. Overall, they noted that PPI therapy as an add-on to standard care was associated with an additional 0.36% decrease in HbA1c compared with standard therapy and lowered fasting blood sugar by 10 mg/dL based on the results from seven clinical trials.

In those without diabetes, the results of the five studies demonstrated that PPIs had no effect on reducing the risk of developing diabetes. They concluded that add-on PPI therapy improved glycemic indices among individuals with diabetes but did not alter the risk of incident diabetes. Additionally, they noted that the effects of PPIs on glycemic control should be considered when prescribing antacids to patients with diabetes.

In response to the study findings, health experts indicated that more research is needed to better understand if and how PPIs could be used to improve blood sugar levels. Dr. Marilyn Tan, an endocrinologist with Stanford Health Care in Palo Alto, California, stated, "The proposed mechanism is that PPIs elevated gastrin levels, and gastrin may improve insulin resistance and insulin response, thus helping to lower blood glucose. However, further studies in humans are needed in order to draw such a conclusion." Dr. Tan also stated that, "Unless the patient has a gastrointestinal indication to be on antacids, I would not recommend starting antacids purely with the hope that it will help diabetes. If a patient with diabetes needs PPIs for gastrointestinal issues, "the patient and the physician should feel comfortable starting the PPI without worrying that it will significantly worsen diabetes. PPIs are not FDA approved for blood sugar control and have not been studied in clinical trials for blood sugar lowering."

Dr. Tan also noted, "The findings are encouraging, but association is not causation." He added that there are many limitations to meta-analysis studies, such as this one, and randomized, controlled trials are needed to examine the direct impact of PPIs on glucose levels in individuals with diabetes. With regard to the meta-analysis, Dr. Tan stated, "Effects are often multivariate, the quality of the studies included is not guaranteed, and there can be many biases."

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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