Diabetes: A Risk Factor for PPI Failure?

JANUARY 21, 2013
Jeannette Y. Wick, RPh, MBA, FASCP
Diabetes patients appear to be at significantly increased risk of experiencing proton pump inhibitor (PPI) failure. In addition, PPIs may be an effective means of increasing glycemic control in diabetes patients.

Many diabetes patients suffer from acid reflux, and most clinicians believe that the prevalence of gastroesophageal reflux disease (GERD) is elevated among those with diabetes. Proton pump inhibitors (PPIs) are the main therapy for GERD, and most patients report significant improvement in or elimination of their symptoms when treated. A study that appeared in the September 2012 edition of the Journal of Clinical Gastroenterology set out to determine if diabetes patients are at increased risk of experiencing PPI failure.
The study identified 732 patients in a 5-year period using the US Department of Veterans Affairs database. Of these patients, 285 experienced PPI failure. Increasing age, female gender, smoking, higher alcohol consumption, and higher BMI values were associated with an increased risk of PPI failure. Even after adjusting for these risk factors, PPI patients with type 2 diabetes mellitus (T2DM) were significantly more likely to experience PPI failure than patients without diabetes. The risk of PPI failure was particularly elevated for diabetes patients who were obese or had comorbidities, while diabetes patients who maintained good control of their diabetes were much less likely to experience PPI failure.
PPIs have also been proposed as a potential agent for controlling blood sugar levels in diabetes patients. A literature review in the February 2013 edition of Endocrine investigates this possible use for PPIs. Some studies indicate that PPIs have the ability to reduce HbA1c by approximately 0.6 to 0.7 percentage points. PPIs decrease acid and increase gastrin release which in turn increases the gastric β-cell mass, which has been associated with improved glycemic control. Alternatively, delayed gastric emptying may lower HbA1c. Prospective, controlled studies are needed to determine whether PPIs or similar drugs may be useful in treating diabetes patients.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.