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PPIs associated with increased risk of type 2 diabetes

Reuters Health - 08/10/2020 - Proton pump inhibitors (PPIs) are associated with increased risk of developing type 2 diabetes, particularly with long-term use, a prospective analysis suggests.

Researchers examined data on 204,689 participants without type 2 diabetes at baseline in the Nurses' Health Study (NHS), NHS II, or Health Professionals Follow-up Study (HPFS). After 2.13 million person-years of follow-up, researchers identified 10,105 incident cases of type 2 diabetes.

Overall, regular PPI users had a higher risk of developing type 2 diabetes than non-users (hazard ratio 1.24), researchers report in Gut.

The risk of type 2 diabetes increased with longer-duration PPI usage, and was lower among those who took PPIs for less than two years (adjusted HR 1.05) than those taking PPIs for more than two years (aHR 1.26), compared with non-users of PPIs.

"Physicians should be aware of the potential risk of type 2 diabetes when prescribing PPIs, particularly for long-term treatment," said lead study author Jinqiu Yuan of Sun Yat-Sen University in Shenzhen, China.

"Screening for abnormal blood glucose and type 2 diabetes may be required for regular PPI users, particularly for high-risk populations," Yuan said by email.

At baseline, and every two years after that, participants in the three studies used for the current analysis provided updated demographic information and details about their health behaviors and any newly diagnosed medical conditions. Median follow-up was 12 years in the NHS and NHS II studies and 9.8 years in the HPFS study.

There were 13,528 regular PPI users at baseline, defined as people who took these drugs at least twice a week. Compared with participants who didn't regularly use PPIs, those who did typically got less exercise, had higher rates of hypertension and hypercholesterolemia, and were more likely to use steroids and NSAIDs.

Among regular PPI users, the absolute risk of developing type 2 diabetes was 7.44 per 1,000 person-years, compared with 4.32 per 1,000 person-years among non-users.

The risk of type 2 diabetes among PPI users did not appear to differ based on age, sex, smoking status, alcohol use, dietary quality, physical activity levels, family history of diabetes, hyperlipidemia, or use of NSAIDs.

One limitation of the analysis is that the NHS, NHS II and HPFS studies didn't collect detailed information on PPI dosage, frequency of usage, brand of medication, or indication for the prescription, the researchers note.

It's possible that the association between PPIs and the risk of developing type 2 diabetes might be confounded by the indication for PPI usage, the study team points out.

Even so, clinicians should be aware of the potential risk, and also communicate this to patients, said Dr. Wojciech Marlicz of the department of gastroenterology at Pomeranian Medical University in Szczecin, Poland.

"Medical practitioners should be aware of this potential risk and should adhere to current guidelines for prescribing PPIs," Dr. Marlicz, who wasn't involved in the study, said by email. "The problem is that PPIs are frequently sold as over-the-counter drugs and not controlled by medical prescriptions."

By Lisa Rapaport

SOURCE: https://bit.ly/3nrYmXP Gut, online September 28, 2020.

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