PPIs are used to treat acid reflux, peptic ulcers, and indigestion. They are among the top 10 most commonly used drugs worldwide.
In 2014, the global prevalence of type 2 diabetes was 8.5%, and the researchers wanted to find out if the widespread use of PPIs and the high prevalence of diabetes might be linked.
They drew on information supplied by 204 689 participants aged 25 to 75 in the US Nurses’ Health Study, which started in 1976 (NHS), the NHS II, which started in 1989, and the Health Professionals Follow-up Study (HPFS), which started in 1986.
At enrolment and every 2 years after that, participants updated information on their health behaviors, medical history, and newly diagnosed conditions.
Starting in 2000 for the NHS, 2001 for NHS II, and 2004 for the HPFS, participants were also asked whether they had used PPIs regularly in the preceding 2 years: regular use was defined as 2 or more times a week.
During the average tracking period of around 9 to 12 years across all three groups, 10,105 participants were diagnosed with type 2 diabetes. The annual absolute risk of a diagnosis among regular PPI users was 7.44/1000 compared with 4.32/1000 among those who didn’t take these drugs.
After taking account of potentially influential factors, including high blood pressure, high cholesterol, physical inactivity and use of other medication, those who regularly used PPIs were 24% more likely to develop type 2 diabetes than those who didn’t.
And the longer these drugs were taken, the greater was the risk of developing diabetes: use for up to 2 years was associated with a 5% increased risk; use for more than 2 years was associated with a 26% increased risk.
A mounting body of evidence suggests that changes in the type and volume of bacteria in the gut (the microbiome) may help explain the associations found between PPI use and an increased risk of developing diabetes, they add.
“Owing to wide usage, the overall number of diabetes cases associated with PPI use could be considerable,” they warn.
Given the range of side effects and the heightened risk of diabetes, doctors should carefully weigh up the pros and cons of prescribing these drugs, they caution. “For patients who have to receive long term PPI treatment, screening for abnormal blood glucose and type 2 diabetes is recommended,” they suggest.
Jinqiu Yuan, Qiangsheng He, Long H Nguyen, Martin C S Wong, Junjie Huang, Yuanyuan Yu, Bin Xia, Yan Tang, Yulong He, Changhua Zhang. Regular use of proton pump inhibitors and risk of type 2 diabetes: results from three prospective cohort studies. Gut, 2020; gutjnl-2020-322557 DOI: 10.1136/gutjnl-2020-322557
BMJ. “Regular use of acid reflux drugs linked to heightened risk of type 2 diabetes: Blood glucose check-ups advised for long term users, advise researchers.” ScienceDaily. ScienceDaily, 28 September 2020. <www.sciencedaily.com/releases/2020/09/200928191238.htm>.
Photo by Hal Gatewood