OTC antacids may modestly improve glucose in type 2 diabetes
Add-on proton pump inhibitor therapy improved glycemic markers among adults with type 2 diabetes, but did not alter risk for incident diabetes, according to a meta-analysis published in The Journal of Clinical Endocrinology & Metabolism.
There is a higher prevalence of upper gastrointestinal symptoms among adults with diabetes, especially among those with poor glycemic response, Kashif M. Munir, MD, vice chief and associate professor of medicine in the division of endocrinology, diabetes and nutrition at the University of Maryland School of Medicine, and colleagues wrote in the study background. Despite emerging evidence of the potential glucose-lowering effect of proton pump inhibitors (PPIs) in diabetes and reduced risk for incident diabetes among individuals without diabetes who use PPI therapy, the effect of PPIs on these two populations remains unclear, they wrote.
“PPIs are very commonly used medications and may have an impact on the incretin axis,” Carol Chiung-Hui Peng, MD, resident physician in the department of internal medicine at the University of Maryland Medical Center Midtown Campus in Baltimore and a study co-investigator, told Healio. “Our meta-analysis shows that PPIs have a modest, but statistically significant effect on improving glucose levels in patients with diabetes.”
Munir and colleagues analyzed data from seven studies that assessed whether PPI therapy can improve glycemic response among adults with type 2 diabetes (n = 342) and from five studies assessing whether PPIs could decrease risk for incident diabetes in the general population (n = 244,439). Studies compared HbA1c or fasting blood glucose among those with diabetes treated with and without PPI therapy as an add-on to standard therapy. Researchers used weighted mean differences between groups or relative risks, calculated using random-effects models.
Compared with standard therapy, add-on PPI therapy was associated with a significant decrease in HbA1c (weighted mean difference, –0.36%; 95% CI, –0.68 to –0.05) and fasting blood glucose (weighted mean difference, –10 mg/dL; 95% CI, –19.4 to –0.6).
PPI use did not reduce the risk for incident diabetes, with a pooled RR of 1.1 (95% CI, 0.89-1.34).
The researchers substantial between-study heterogeneity and non-robustness in “leave-one-out” sensitivity analyses, meaning findings need to be confirmed in additional studies. However, the findings demonstrate the “therapeutic potential” of PPI therapy in diabetes, researchers wrote.
“Proton pump inhibitor use is common, and providers should be aware of their potential effects on glycemic control in patients with diabetes,” Munir told Healio. “More data are needed to determine if concurrent therapy of PPIs with other drugs [that] have incretin effects, such as GLP-1 receptor agonists or DPP-IV inhibitors, may have additive glycemic benefits, as has been suggested from preclinical studies.”
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Kashif M. Munir, MD, can be reached email@example.com