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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 4  |  Issue : 3  |  Page : 388-393

The relationship between Helicobacter pylori infection and control of type 2 diabetes mellitus


1 Department of Internal Medicine, Faculty of Medicine for Gairls, Alazher University, Egypt
2 Department of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt

Date of Submission28-Apr-2020
Date of Decision14-May-2020
Date of Acceptance19-May-2020
Date of Web Publication2-Oct-2020

Correspondence Address:
BSc Shimaa Y Eisa
Department of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjamf.sjamf_50_20

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  Abstract 


Backgrou nd Dyspepsia is a common symptom with a heterogeneous pathophysiology. It occurs in at least 20% of the population. Helicobacter pylori is one of the most common human bacterial pathogen that is present in ∼50% of the global population. It normally is a resident of gastric epithelium. Type 2 diabetes mellitus (T2DM) is a major public health problem, with increasing prevalence globally. It is a metabolic disorder that occurs owing to insulin resistance and relative insulin deficiency.
Objectives To study the association between H. pylori infection and T2DM and glycated hemoglobin (HbA1c) and comparing it with nondiabetic patients.
Patients and methods This cross-section study was conducted on 60 patients with age more than or equal to 35 years, of either sex, with history of dyspepsia. There were 20 (33%) males and 40 (67%) females, and their ages ranged between 35 and 62 years, with mean age of 46.5±9.15 years. They were divided into two groups of patients: group I included 30 patients with T2DM, and group II included 30 nondiabetic patients. Patients in group II are subdivided into two groups (according to HbA1c results): group IIA (prediabetic) included 13 patients, and group IIB (nondiabetic) included 17 patients.
Results H. pylori infection is significantly associated with T2DM, and the incidence of H. pylori in type 2 diabetic patients was significantly higher than nondiabetic patients. H pylori infection is significantly associated with HbA1c level, and HbA1c in H. pylori-positive group was significantly higher than H. pylori-negative group. Moreover, H. pylori infection is significantly associated with prediabetes, and the incidence of H. pylori in prediabetic patients was significantly higher than nondiabetic patients.
Conclusion The incidence of H. pylori infection was significantly higher in T2DM and prediabetes than nondiabetic patients. Moreover, H. pylori was significantly associated with increased HbA1c level. Further studies are needed to evaluate the effect of H. pylori eradication in glycemic control of T2DM and prediabetes and the effect of glycemic control on reinfection with H. pylori.

Keywords: Helicobacter pylori, type 2 diabetes mellitus, dyspepsia


How to cite this article:
Eisa SY, Ahmed KY, El Sayed WE. The relationship between Helicobacter pylori infection and control of type 2 diabetes mellitus. Sci J Al-Azhar Med Fac Girls 2020;4:388-93

How to cite this URL:
Eisa SY, Ahmed KY, El Sayed WE. The relationship between Helicobacter pylori infection and control of type 2 diabetes mellitus. Sci J Al-Azhar Med Fac Girls [serial online] 2020 [cited 2020 Oct 28];4:388-93. Available from: http://www.sjamf.eg.net/text.asp?2020/4/3/388/296946




  Introduction Top


Dyspepsia is a worldwide problem that affects 40% of adults. Approximately 10% of all patients presenting for endoscopy for gastrointestinal symptoms have dyspepsia [1].

Helicobacter pylori is a gram-negative spiral flagellate bacillus, which normally is a resident of gastric epithelium, It can cause inflammatory cell infiltration in gastric mucosa that produces cytokines, which are not only responsible for local effects but can damage remote tissues causing extradigestive diseases like ischemic heart disease, autoimmune thyroid disease, iron deficiency anemia, idiopathic thrombocytopenic purpura, and neurologic diseases [1].

In addition to this, it is also thought to play a direct or indirect role in the pathogenesis of metabolic syndrome, non-alcoholic fatty liver disease, and type 2 diabetes [2].

Diabetes mellitus (DM) is a major public health problem, with increasing prevalence globally. The major burden (90–95%) is caused by type 2 diabetes mellitus (T2DM), which typically develops in adulthood and is characterized by variable levels of insulin resistance, impaired insulin secretion, and increased glucose production [3].

Prediabetes is a disorder in which concentration of blood glucose is more elevated than normal levels, but it is not high enough for a diagnosis of DM. Prediabetes occurs in patients having insulin resistance. Prediabetes ultimately converts into T2DM. Prediabetes along with insulin resistance is an important etiology of metabolic syndrome [1].

The association between DM and H. pylori infection remains controversial, although many studies have been done, which concluded that a definite relationship exists between the two. It is hypothesized that H. pylori infection promotes atherosclerosis by altering lipid metabolism, and this leads to the metabolic syndrome, insulin resistance, and finally, to type 2 diabetes [2].

There are several lines of evidence to implicate increased susceptibility to H. pylori infection in diabetic patients. First, a diabetes-induced impairment of cellular and humoral immunity may enhance an individual’s sensitivity to H. pylori infection. Second, diabetes-induced reduction of gastrointestinal motility and acid secretion may promote pathogen colonization and infection rate in the gut. Third, altered glucose metabolism may produce chemical changes in the gastric mucosa that promote H. pylori colonization [4].


  Aim Top


The aim is to study the association of H. pylori infection with T2DM and its relation with glycated hemoglobin (HbA1c) levels and comparing it with nondiabetic patients.


  Patients and methods Top


This cross-sectional study was conducted on 60 patients with age more than or equal to 35 years, of either sex, with history of dyspepsia, bloating, or epigastric discomfort for more than 3 months.

There were 20 (33%) males and 40 (67%) females. Their ages ranged between 35 and 62 years, with mean age of 46.5±9.15 years. They were selected from patients attending Al Zahraa Hospital (Endoscopic Unit of Gastroenterology Department) and during the period from December 2018 to September 2019. This study was conducted at Faculty of Medicine for Girls, Al Azhar University.

The patients were divided into two groups.

Group I included 30 patients with T2DM, and group II included 30 nondiabetic patients. Patients in group II are subdivided into two groups (according to HbA1c results): group IIA (prediabetic) included 13 patients, and group IIB (nondiabetic) included 17 patients.

Ethical consideration

An oral consent was obtained from all patients before getting them involved in the study.

All cases in this study were subjected to the following:
  1. Full clinical history with detailed history about T2DM (its duration and treatment).
  2. Full medical examination, including BMI using the formula: weight (kg)/height (m2).
  3. Laboratory investigation, including the following:
    1. Complete blood picture.
    2. Fasting blood sugar (FBS).
    3. Postprandial blood sugar (PP-BS) (2 h after 75 g glucose orally).
    4. HbA1c.
    5. Kidney function tests (serum creatinine and blood urea).
    6. Liver function tests (serum albumin, ALT, and AST).
    7. Lipid profile, which include cholesterol and triglyceride.
  4. All patients underwent upper gastrointestinal endoscopy, and antral biopsy was obtained and samples were sent to Pathology Department for histopathological examination and rapid urease test for diagnosis of H. pylori infection.


Exclusion criteria

The following were the exclusion criteria:
  1. Patients with T1DM.
  2. Patients with age less than 35 years.
  3. Patients with history of NSAIDs or alcohol intake.
  4. Patients already on steroid or immunosuppressive.
  5. Patients on proton pump inhibitors.
  6. Patients with history of H. pylori-eradication therapy in the previous 6 months.
  7. Patients with diagnosed malignancy in previous medical records.
  8. Patients with history of hematemesis.
  9. Patients with severe weight loss.


Statistical analysis

Data were collected, revised, coded, tabulated, and entered to the computer using Statistical Package for the Social Science program for statistical analysis (version 25), IBM SPSS Statistics for windows, version 25, (IBM Corp., Armonk, New York, USA).

The data were presented as number and percentages for the qualitative data, and mean and SDs for the quantitative data with parametric. P value was used to explain the level of significance as follows: P value more than 0.05 nonsignificant, P value less than 0.05 significant, and P value less than 0.01 highly significant.


  Results Top


[Table 1] shows that there is no statistically significant difference in sex, age, and BMI between group I and group II.
Table 1 Comparison between group I and group II according to demographic data

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[Table 2] shows a highly statistically significant increase in H. pylori in group I and group IIA compared with group IIB (P<0.001).
Table 2 Comparison among all groups regarding Helicobacter pylori infection

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[Table 3] shows a highly statistically significant increase in HbA1c, FBS, and PP-BS in group I and group IIA compared with group IIB (P<0.001).
Table 3 Comparison among all groups regarding glycated hemoglobin, fasting blood sugar, and postprandial blood sugar

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[Table 4] shows a highly statistically significant increase in H. pylori in group I compared with group IIB (P<0.001).
Table 4 Comparison between group 1 and group 2B regarding Helicobacter pylori infection

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[Table 5] shows a highly statistically significant increase in HbA1c, FBS, and PP-BS in group I compared with group IIB (P<0.001).
Table 5 Comparison between group 1 and group 2B regarding glycated hemoglobin, fasting blood sugar, and postprandial blood sugar

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[Table 6] shows a highly statistically significant increase in H. pylori infection in group IIA compared with group IIB (P<0.001).
Table 6 Comparison between group IIA and group IIB regarding Helicobacter pylori infection

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[Table 7] shows a highly statistically significant increase in HbA1c, FBS, and PP-BS in H. pylori-positive compared with H. pylori-negative groups (P<0.001).
Table 7 Comparison between Helicobacter pylori-positive and Helicobacter pylori-negative groups regarding glycated hemoglobin, fasting blood sugar, and postprandial blood sugar

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  Discussion Top


H. pylori is a gram-negative, spiral-shaped pathogenic bacterium that specifically colonizes the gastric epithelium causing chronic gastritis, peptic ulcer disease, and/or gastric malignancy [5].

H. pylori is mainly acquired in childhood by the fecal-oral, oral-oral, or gastro-oral route and has been recognized as a worldwide public health problem, which is more prevalent in developing countries [6].

H. pylori infection induces an acute polymorphonuclear infiltration in the gastric mucosa, which is gradually replaced by an immunologically mediated, chronic, predominantly mononuclear cellular infiltration. The mononuclear infiltration is characterized by the local production and systemic diffusion of proinflammatory cytokines that can affect remote tissues and organic systems [7].

As a result, an increased prevalence of extradigestive diseases has been reported in those with evidence of H. pylori infection in recent years, including ischemic heart disease, autoimmune thyroid diseases, sideropenic anemia, idiopathic thrombocytopenic purpura, neurologic diseases, and hepatobiliary diseases [8].

T2DM is an emerging pandemic, responsible for an estimated 3.8 million adult deaths worldwide [9].

The pathogenesis of T2DM is complex, with risk factors associated with lifestyle (e.g. diet, obesity, and physical activity), genetic background, and socioeconomic factors [10].

In T2DM, the pancreas can no longer produce enough insulin to overcome the cellular loss of sensitivity, resulting in the accumulation of sugar in the bloodstream [11].

Identification of treatable causes of this disease will aid in the development of strategies to delay or prevent its onset or slow its progression. Recent evidence implicates the pathological involvement of inflammation in T2DM, which is an important process induced by H. pylori infection [12].

The link between H. pylori infection and diabetes remains controversial, as some studies indicate a higher prevalence of infection in diabetic patients, whereas others report no difference [4].

So, our study was done to evaluate the association of H. pylori infection with T2DM and its relation with HbA1c levels and comparing it with nondiabetic patients.

Our cross-sectional study was conducted on 60 patients with age more than or equal to 35 years, of either sex, with history of dyspepsia, bloating, or epigastric discomfort for more than 3 months.

There were 20 (33%) males and 40 (67%) females, and their ages ranged between 35 and 62 years, with a mean age of 46.5±9.15 years.

They were divided into two groups of patients:
  • Group I included 30 patients with T2DM.
  • Group II included 30 nondiabetic patients.


Patients in group II were subdivided into two groups (according to HbA1c results):
  • Group IIA (prediabetic) included 13 patients.
  • Group IIB (nondiabetic) included 17 patients.


Our results showed that H. pylori infection is significantly associated with T2DM, and the incidence of H. pylori in type 2 diabetic patients was significantly higher than nondiabetic patients.

Our results agreed with Candelli et al. [13], who reported that the prevalence of H. pylori infection was higher in diabetics (24%) than in controls of similar age, sex, and socioeconomical status after 3 years of follow-up, and the reinfection rate was higher in diabetic patients.

However, it was in contrast with Xia et al. [14], who reported that there was no difference in H. pylori prevalence between patients with DM and non-DM controls.

Our results showed that H. pylori infection is significantly associated with HbA1c level, and HbA1c in H. pylori-positive group was significantly higher than H. pylori-negative group.

Our results agreed with Chen and Blaser [15], who reported that H. pylori infection was positively associated with HbA1c levels through a large-scale cross-sectional analysis, which indicated a role of H. pylori in impaired glucose tolerance in adults. In contrast, Gillum [16] reported that H. pylori infection status was not significantly associated with HbA1c in men aged 40–70 years with or without history of type 2 diabetes.

Our results showed that H. pylori infection is significantly associated with prediabetes.

Our results agreed with Han et al. [17], who reported that H. pylori infection had strong relationship with elevated risk of type 2 diabetes; Kato et al. [18], who reported that H. pylori infection is associated with an increased risk of DM; Jeon et al. [19], who reported that patients who were positive for H. pylori were 2.7 times more likely at any given time to develop type 2 diabetes than negative individuals; So et al. [20], who reported that H. pylori interdependently can predict dysfunction of pancreatic beta-cells; and Rahman et al. [21], who reported a positive relationship between H. pylori infection and defective insulin secretion, so that insulin molecules are highly susceptible to damage from oxidative stress and inflammation. Hence, Helicobacter inflammation probably causes defection in insulin production.However, the results were in contrast to Stanciu et al. [22], who reported that H. pylori infection had no significant relation with diabetes itself nor its duration or severity of dyspeptic symptoms in diabetic patients, as well as in contrast to Oluyemi et al. [23], who reported that there was no indicative association of the H. pylori infection with DM.


  Conclusion Top


The incidence of H. pylori infection was significantly higher in T2DM and prediabetes than nondiabetic patients. Moreover H. pylori was significantly associated with increased HbA1c level. Further studies are needed to evaluate the effect of H. pylori eradication in glycemic control of T2DM and prediabetes and the effect of glycemic control on reinfection with H. pylori.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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