A Study of Relationship of Helicobacter Pylori Infection with Glycemic Control and Insulin Resistance in Adults with Type 2 Diabetes Mellitus
A Study of Relationship of Helicobacter Pylori Infection with Glycemic Control and Insulin Resistance
DOI:
https://doi.org/10.70284/njirm.v9i1.1860Keywords:
Helicobacter pylori; Diabetes Mellitus, Type 2; Hemoglobin A, Glycosylated; Insulin ResistanceAbstract
Background & Objectives: There are contradictory reports about whether any association exists between Helicobacter pylori (HP) infection and type 2 diabetes mellitus (Type 2 DM). Ouraim was to study the possible inter-relationship between HP infection, glycosylated hemoglobin (HbA1c) levels and Homoeostatic Model Assessment for Insulin Resistance (HOMA – IR) in type 2 diabetic dyspeptic patients referred for upper gastrointestinal endoscopy. Methods: The study was done on 100 dyspeptic patients – 50 with type 2 DM and 50 non-diabetic controls. Their antral and corpus biopsy samples were subjected to Rapid urease test for detection of HP. The diabetics were divided into those with and without HP infection into HP+ and HP- groups. Detailed history was taken and the following investigations were done – body mass index, waist circumference, fasting and post prandial blood sugar levels, HbA1c, fasting insulin levels and HOMA-IR for all patients. Results: HP infection was associated with type 2 DM in a statistically significant manner (P = 0.001). The mean age of HP+ diabetics was 54.89 ± 11 years and that of HP- was 56.56 ± 11.2 years. Mean body mass index of HP+ diabetics was 30.58 ± 3.2 kg/m2 and that of HP- was 28.6 ± 2.5 kg/m2. HP infection was associated in a statistically significant manner with high BMI and waist circumference in diabetics (P = 0.02 and P = 0.0049). Mean HbA1c in HP+ was 8.23±1.34% and in HP- was 8.62±1.6% (P=0.31). Average fasting insulin levels in HP+ was 8.7 ± 4.1μIU/ml and in HP- was 7.4 ± 3.7 μIU/ml (P=0.24) . Mean HOMA-IR was 4.3 ± 2.3 in HP+ and 3.7 ± 2.3 in HP- diabetics (P=0.34).Conclusion: Helicobacter pylori although significantly associated with type 2 DM as compared to non-diabetics, there was no correlation found with poor glycemic control or insulin resistance in them. Obese diabetics with high waist circumference had statistically significant higher prevalence of HP infection as compared to non-obese diabetics.
References
2. Amieva M, Peek RM. Pathobiology of Helicobacter pylori–induced gastric cancer. Gastroenterology. 2016 Jan 31;150(1):64-78.
3. Mendall MA, Goggin PM, Molineaux N, Levy J, Toosy T, Strachan D, Camm AJ, Northfield TC. Relation of Helicobacter pylori infection and coronary heart disease. Heart. 1994 May 1;71(5):437-9.
4. Banid M, Franceschi F, Babid Z, Gasbarrini A. Extragastric manifestations of Helicobacter pylori infection. Helicobacter. 2012 Sep 1;17(s1):49-55.
5. Pasceri V, Cammarota G, Patti G, Cuoco L, Gasbarrini A, Grillo RL, Fedeli G, Gasbarrini G, Maseri A. Association of virulent Helicobacter pylori strains with ischemic heart disease. Circulation. 1998 May 5;97(17):1675-9.
6. Kim HL, Jeon HH, Park IY, Choi JM, Kang JS, Min KW. Helicobacter pylori infection is associated with elevated low density lipoprotein cholesterol levels in elderly Koreans. Journal of Korean medical science. 2011 May 1;26(5):654-8.
7. Buzás GM. Metabolic consequences of Helicobacter pylori infection and eradication. World journal of gastroenterology: WJG. 2014 May 14;20(18):5226.
8. Dore MP, Bilotta M, Malaty HM, Pacifico A, Maioli M, Graham DY, Realdi G. Diabetes mellitus and Helicobacter pylori infection. Nutrition. 2000 Jun 30;16(6):407-10.
9. Go MF. Natural history and epidemiology of Helicobacter pylori infection. Alimentary pharmacology & therapeutics. 2002 Mar 1;16(s1):3-15.
10. Brown LM. Helicobacter pylori: epidemiology and routes of transmission. Epidemiologic reviews. 2000 Jan 1;22(2):283-97.
11. Salih BA. Helicobacter pylori infection in developing countries: the burden for how long?. Saudi journal of gastroenterology: official journal of the Saudi Gastroenterology Association. 2009 Jul;15(3):201.
12. Zhou X, Zhang C, Wu J, Zhang G. Association between Helicobacter pylori infection and diabetes mellitus: a meta-analysis of observational studies. Diabetes Research and Clinical Practice. 2013 Feb 28;99(2):200-8.
13. Devrajani BR, Shah SZ, Soomro AA, Devrajani T. Type 2 diabetes mellitus: A risk factor for Helicobacter pylori infection: A hospital based case-control study. International journal of diabetes in developing countries. 2010 Jan;30(1):22.
14. Wafula JM, Lule GN, Otieno CF, Nyon’o A, Sayed M. Upper gastrointestinal findings in diabetic outpatients at Kenyatta National Hospital, Nairobi. East African medical journal. 2002;79(5):232-6.
15. Bajaj S, Rekwal L, Misra SP, Misra V, Yadav RK, Srivastava A. Association of helicobacter pylori infection with type 2 diabetes. Indian journal of endocrinology and metabolism. 2014 Sep;18(5):694.16. Gulcelik NE, Kaya E, Demirbas BE, Culha CA, Koc G, Ozkaya M, Cakal E, Serter R, Aral Y. Helicobacter pylori prevalence in diabetic patients and its relationship with dyspepsia and autonomic neuropathy. Journal of endocrinological investigation. 2005 May 1;28(5):214-7.
17. Longo-Mbenza B, Nsenga JN, Ngoma DV. Prevention of the metabolic syndrome insulin resistance and the atherosclerotic diseases in Africans infected by Helicobacter pylori infection and treated by antibiotics. International journal of cardiology. 2007 Oct 18;121(3):229-38.
18. Anastasios R, Goritsas C, Papamihail C, Trigidou R, Garzonis P, Ferti A. Helicobacter pylori infection in diabetic patients: prevalence and endoscopic findings. Eur J Intern Med 2002;13(6):376.
19. Demir M, Gokturk HS, Ozturk NA, Kulaksizoglu M, Serin E, Yilmaz U. Helicobacter pylori prevalence in diabetes mellitus patients with dyspeptic symptoms and its relationship to glycemic control and late complications. Dig Dis Sci 2008;53(10):2646-9.
20. Vecchio TJ. Predictive value of a single diagnostic test in unselected populations. New England Journal of Medicine. 1966 May 26;274(21):1171-3.
21. Ikeda F, Doi Y, Yonemoto K, Ninomiya T, Kubo M, Shikata K, Hata J, Tanizaki Y, Matsumoto T, Iida M, Kiyohara Y. Hyperglycemia increases risk of gastric cancer posed by Helicobacter pylori infection: a population-based cohort study. Gastroenterology. 2009 Apr 30;136(4):1234-41.
22. Butler SO, Btaiche IF, Alaniz C. Relationship between hyperglycemia and infection in critically ill patients. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2005 Jul 1;25(7):963-76.
23. Bener A, Micallef R, Afifi M, Derbala M, Al-Mulla HM, Usmani MA. Association between type 2 diabetes mellitus and Helicobacter pylori infection. Turk J Gastroenterol. 2007 Dec 1;18(4):225-9.
24. Gasbarrini A, Franceschi F, Cammarota G, Pola P, Gasbarrini G. Vascular and immunological disorders associated with Helicobacter pylori infection. Italian journal of gastroenterology and hepatology. 1998 Feb;30(1):115-8.
25. Bytzer P, Talley NJ, Hammer J, Young LJ, Jones MP, Horowitz M. GI symptoms in diabetes mellitus are associated with both poor glycemic control and diabetic complications. The American journal of gastroenterology. 2002 Mar 1;97(3):604-11.
26. Perdichizzi G, Bottari M, Pallio S, Fera MT, Carbone M, Barresi G. Gastric infection by Helicobacter pylori and antral gastritis in hyperglycemic obese and in diabetic subjects. The new microbiologica. 1996 Apr;19(2):149-54.
27. Wu MS, Lee WJ, Wang HH, Huang SP, Lin JT. A case-control study of association of Helicobacter pylori infection with morbid obesity in Taiwan. Archives of internal medicine. 2005 Jul 11;165(13):1552-5.
28. Horikawa C, Kodama S, Fujihara K, Yachi Y, Tanaka S, Suzuki A, Hanyu O, Shimano H, Sone H. Association of Helicobacter pylori infection with glycemic control in patients with diabetes: a meta-analysis. Journal of diabetes research. 2014 May 8;2014.
29. Wada Y, Hamamoto Y, Kawasaki Y, Honjo S, Fujimoto K, Tatsuoka H, Matsuoka A, Ikeda H, Fujikawa J, Koshiyama H. The eradication of Helicobacter pylori does not affect glycemic control in Japanese subjects with type 2 diabetes. Japanese clinical medicine. 2013;4:41.
30. Gen R, Demir M, Ataseven H. Effect of Helicobacter pylori eradication on insulin resistance, serum lipids and low-grade inflammation. Southern Medical Journal. 2010 Mar;103(3):190-6.
31. Dai YN, Yu WL, Zhu HT, Ding JX, Yu CH, Li YM. Is Helicobacter pylori infection associated with glycemic control in diabetics?. World Journal of Gastroenterology: WJG. 2015 May 7;21(17):5407.
32. Xiang Z. Analysis of expression of Cag A and VacA virulence factors in 43 strains of Helicobacter pylori reveals that Cag A is not necessary for expression of vacuolatingcytotoxin. Infect Immun. 1995;63:94-8.
33. Ibrahim A, Zaher T, Ghonemy TA, El-Azim SA, El-Azim MA, Ramadan A. Impact of cytotoxin-associated gene A of Helicobacter pylori strains on microalbuminuria in type 2 diabetes. Saudi Journal of Kidney Diseases and Transplantation. 2010 Jul 1;21(4):694.