Association between gastrointestinal tract infections and glycated hemoglobin in school children of poor neighborhoods in Port Elizabeth, South Africa

Abstract

BackgroundLow- and middle-income countries are facing a dual disease burden with infectious diseases (e.g., gastrointestinal tract infections) and non-communicable diseases (e.g., diabetes) being common. For instance, chronic parasite infections lead to altered immune regulatory networks, anemia, malnutrition, and diarrhea with an associated shift in the gut microbiome. These can all be pathways of potential relevance for insulin resistance and diabetes. The aim of this study was to investigate the association between common gastrointestinal tract infections and glycemia in children from non-fee paying schools in South Africa.MethodologyWe conducted a cross-sectional survey among 9- to 14-year-old school children in Port Elizabeth. Stool and urine samples were collected to assess infection status with parasitic worms (e.g., Ascaris lumbricoides, Enterobius vermicularis, and Trichuris trichiura), intestinal protozoa (e.g., Cryptosporidium parvum and Giardia intestinalis), and the bacterium Helicobacter pylori. Glycated hemoglobin (HbA1c) was measured in finger prick derived capillary blood. All children at schools with a high prevalence of helminth infections and only infected children at the schools with low infection rates were treated with albendazole. The association of anthelmintic treatment with changes in HbA1c 6 months after the drug intervention was also investigated.FindingsA high prevalence of 71.8% of prediabetes was measured in this group of children, with only 27.8% having HbA1c in the normal range. H. pylori was the predominant infectious agent and showed an independent positive association with HbA1c in a multivariable regression analysis (β = 0.040, 95% confidence interval (CI) 0.006–0.073, p<0.05). No association of HbA1c with either any other infectious agent or albendazole administration was found.ConclusionThe role of H. pylori in diabetes needs confirmation in the context of longitudinal treatment interventions. The specific effect of other gastrointestinal tract infections on glycemia remains unclear. Future studies should integrate the measurement of biomarkers, including immunological parameters, to shed light on the potential mediating mechanisms between parasite infections and diabetes.

Association of urogenital and intestinal parasitic infections with type 2 diabetes individuals: a comparative study

“…Both urogenital schistosomiasis and IPIs have been linked to increased morbidity and mortality and serious complications. Intestinal parasitosis impairs the body's metabolism, nutrition absorption, and gut ecosystem [24][25][26]. A complicated relationship exists between parasitosis and T2DM.…”

Increased Glycated Hemoglobin Levels in Patients With Helicobacter pylori Infection Are Associated With the Grading of Chronic Gastritis

“…In contrast, in other studies of patients with T2DM, a positive association between H. pylori infection and suboptimal glycemic control was shown (19,20). A positive association was previously noted between H. pylori infection and prediabetes (11,12). Draz et al (11) assessed the association between HP and prediabetes in adults using the oral glucose tolerance test (OGTT) for prediabetes diagnosis and histopathological examination for H. pylori diagnosis.…”

“…Yang et al (10) found that gastric H. pylori infection is associated with the risk of diabetes mellitus but not prediabetes. Recent studies have shown a positive association between H. pylori infection and prediabetes (11,12).…”

Association between helminth infections and diabetes mellitus in adults from the Lao People’s Democratic Republic: a cross-sectional study

“…An infection with S. stercoralis was found positively associated with severe DM [ 36 ]. We reported a positive association of H. pylori infections with HbA1c in school children from poor neighbourhoods in South Africa, but neither a cross-sectional association with other common helminth infections nor a change in HbA1c as a result of anti-helminthic treatment [ 37 ]. It has been shown that socioeconomic, environmental and behavioural factors influence the prevalence and intensity of helminth infections and could therefore, in part, be confounders as well as mediators of any association with diabetes [ 18 , 38 ].…”

“…Third, we used an internationally certified HbA1c test, which was able to capture most of the previously diagnosed DM cases. The HbA1c point-of-care method applied was validated for use in hot and remote low-income settings in the context of our previous study in South Africa [ 37 ]. The validity of our HbA1c findings is further supported by their positive association with validated DM risk factors such as age, BMI and smoking.…”