A class of drugs widely used to treat heartburn and stomach ulcers improve blood sugar control in patients with diabetes when added to their usual treatment, a new analysis indicates.
But the same class of drugs — known medically as proton pump inhibitors (PPIs) and including agents such as omeprazole — did not prevent diabetes in people who do not already have it, the same research shows.
As well as working to suppress acid, “We know that these drugs affect certain gut hormones that are important in glucose regulation,” Kashif Munir, MD, told WebMD.
“So if somebody is already on a PPI and they are doing well, then this provides them with some acknowledgement that the PPIs might also be helpful for their diabetes if they have it,” he said.
The study was published online June 25, 2021, in The Journal of Clinical Endocrinology & Metabolism.
Antacids Lowered Two Measures of Diabetes
Munir, an associate professor of endocrinology, diabetes, and nutrition at the University of Maryland School of Medicine in Baltimore, and colleagues examined the results of five studies including almost 250,000 people without diabetes. The researchers didn’t find that using proton pump inhibitors reduces the risk of developing new diabetes in this population.
But then they looked at seven studies involving 342 patients with diabetes to see the effects of PPIs on blood sugar control.
“Overall, PPI therapy as an add-on to standard care was associated with an additional 0.36% decrease in glycosylated hemoglobin (HbA1c) compared with standard therapy,” they report.
Glycosylated hemoglobin is a measure of a patient’s average blood sugar levels for the past 2 to 3 months, and levels of 6.5% or higher on two separate tests are diagnostic for diabetes.
And while a reduction of 0.36% in A1c may sound modest, the FDA considers glucose-lowering drugs for approval if they reduce A1c by as little as 0.3%, Munir noted.
Similarly, the use of PPIs on top of standard anti-diabetes treatment was associated with an additional, although again modest, 10.0 milligrams per deciliter (mg/dL) reduction in fasting blood sugar.
The higher the PPI dose, the better the blood sugar-lowering effect too, the researchers found.
And patients who had poor blood sugar control — reflected by higher A1c — benefited more when they took the antacids than did those whose diabetes was well-controlled to begin with.
The effects of proton pump inhibitor antacids on blood sugar control “should be considered when prescribing antacids to patients with diabetes,” the researchers conclude.
“If you are somebody [with diabetes] who suffers from heartburn, the PPIs could be considered as potentially beneficial therapy to treat both conditions with one medicine,” Munir said.
Sources:
Kashif Munir, MD, associate professor of endocrinology, diabetes, and nutrition, University of Maryland School of Medicine, Baltimore.
The Journal of Clinical Endocrinology & Metabolism: “Effects of Proton Pump Inhibitors on Glycemic Control and Incident Diabetes: A Systematic Review and Meta-Analysis.”
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