Impact of Cytotoxin-Associated Gene Product-A Positive <i>Helicobacter Pylori</i> Strains on Micro-albuminuria in Type 2 Diabetes

Abstract

Introduction: Available data on the possible association between Helicobacter pylori (H. pylori) infection and diabetes mellitus (DM) are contradictory. The prevalence of cytotoxin associated gene product A (cagA) positive H. pylori is high in Egypt. This study aims to examine its association with type 2 DM, and its effect on glycemic control and the occurrence of microalbuminuria. Methods:The study involved 98 dyspeptic type 2 diabetic patients and 102 dyspeptic non-diabetic subjects who underwent upper gastrointestinal tract endoscopy in Zagazig university hospital. H. pylori infection was diagnosed by histopathology and/or culture. The presence of cagA positive strains was confirmed by polymerase chain reaction (PCR) and gel electrophoresis. Fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c) and urinary albumin excretion ratio (UAER) were compared between infected and non-infected diabetic patients.Results: Diabetic patients had similar age and gender distribution but significantly higher body mass index (BMI) compared to controls. The prevalence of H. pylori infection (54.1% versus 56.9%, P = 0.3) and the prevalence of cagA positive H. pylori strains (40.8% versus 36.3%, P =0.1) were not significantly different between the two groups. Diabetic patients infected with cagA positive H. pylori strains had higher mean FBS (199±22 versus 163±20, P=0.00), higher mean HbA1c (8.6±0.8 versus 6.3±0.8, P=0.00) and higher rate of microalbuminuria (67.5% versus 10.3%, P=0.00) than non infected diabetic patients. Conclusion:H. pylori infection with cagA positive strains was similarly common in dyspeptic diabetic patients and controls. It was associated with poorer glycemic control and higher rates of microalbuminuria in diabetic subjects.

Helicobacter pyloriInfection Is Associated with Type 2 Diabetes, Not Type 1 Diabetes: An Updated Meta-Analysis

“…It was reported that H. pylori infection in Asians was predominated by CagA iceA1 genotypes while Americans and Africans by CagA iceA2 genotypes [ 41 , 43 ]. CagA is a major virulence factor of H. pylori and has been reported to be associated with diabetic complications [ 44 ]. CagA -positive strain of H. pylori could cause poor glycemic control in T2DM and difficulty in eradication, which might result in the visible H. pylori effect among Asian but not African DM patients.…”

Helicobacter pyloriand extragastric diseases: A review

“…According to Horikawa et al[ 151 ], the glycemic control of patients with DM was worse in the presence of H. pylori infections, in particular in infections with CagA-positive strains. A few studies demonstrated that eradication could lead to a benefit for glycemic control[ 152 , 153 ]. This has not been confirmed by other studies[ 154 ].…”

“…Vafaeimanesh et al[ 160 ] have demonstrated the existence of an association between diabetic patients with microalbuminuria and H. pylori infection. Microalbuminuria, as well as neuropathy and heart disease, are very common complications in patients with DM, and patients with CagA-positive H. pylori infection are at a greater risk of developing these complications[ 152 , 161 ].…”

Association Between Proteinuria and Active Helicobacter Pylori Infection in Non-Diabetic Patients

“…Many inflammatory mediators were thought to be involved in the pathogenic way of extra digestive disorders caused by Helicobacter pylori infection which include; leukotriene C4, interleukin-1 (IL-1), interferon-(IFN)-γ), interleukin-6(IL-6), platelet-activating factor and tumor necrosis factor alpha-(TNF-α). [10] Proteinuria is a well-known indicator for renal disorders. The relationship between nephrotic range proteinuria (nephrotic syndrome) and hypoalbuminemia, edema, hyperlipidemia, susceptibility to infection, and hypercoagulability state also had been approved.…”