Proton-pump inhibitors (PPIs) may have beneficial glycemic effects in patients with diabetes and do not appear to affect risk for incident diabetes, according to a recent study.
Researchers performed a systematic review and meta-analysis of studies published through Nov. 21, 2020, that compared HbA1c or fasting blood glucose level in patients with diabetes who received PPIs as an add-on to standard therapy versus those who did not. They also looked at studies that examined the risk for incident diabetes in patients taking PPIs. Random-effects models were used to impute relative risks or weighted mean differences between groups. Results were published online June 25 by the Journal of Clinical Endocrinology & Metabolism.
The review included seven studies of 342 patients that looked at glycemic control and five studies of 244,439 patients that looked at risk for incident diabetes. In patients with diabetes, add-on PPI therapy was associated with a significant decrease in HbA1c level (weighted mean difference, −0.36%; P=0.025) and fasting blood glucose level (weighted mean difference, −10.0 mg/dL [−0.6 mmol/L]; P=0.037) versus standard therapy. Use of PPIs did not affect risk for incident diabetes in patients without the disease (pooled relative risk, 1.10; 95% CI, 0.89 to 1.34; P=0.385).
The researchers noted that a limited number of small studies on glycemic control were included and that follow-up was 12 weeks in most studies. The results may also not be generalizable to patients in non-Asian countries, as most studies came from Asia, among other limitations. The study authors concluded that adding PPIs to standard therapy improved glycemic indices in patients with diabetes but did not appear to affect incident diabetes risk. “When patients with diabetes require antacids, clinicians should consider the glycemic control effect of PPI when formulating a treatment plan,” the authors wrote. “Further studies, especially large and high-quality clinical trials, are warranted to confirm our findings and determine causality.”