The Association between Helicobacter pylori Infection and Glycated Hemoglobin A in Diabetes: A Meta-Analysis

Abstract

Background.The association between Helicobacter pylori infection and glycated hemoglobin A has been confirmed in many studies, but these conclusions are still contradictory and controversial. Therefore, we conducted a meta-analysis to resolve the problem of inconsistent results in diabetes.Methods. A comprehensive search was conducted on related researches published in PubMed, Embase, and China Academic Journal Full-text Database (CNKI) from the inception of each database to April 2019. Fixed or random effects model was used to pool the weighted mean difference with 95% confidence interval from individual studies. Subgroup and sensitivity analyses were also performed. Publication bias was estimated by funnel plot, Egger’s test, and fail-safe numbers.Results. 35 studies with 4,401 participants with diabetes were included in the meta-analysis. Glycated hemoglobin A levels were elevated in patients with Helicobacter pylori infection compared with patients without Helicobacter pylori infection (WMD=0.50, 95% CI: 0.28-0.72,p<0.001). In subgroup analysis by the subtype of diabetes, there was a correlation between Helicobacter pylori infection and elevated glycated hemoglobin A in type 1 diabetes (I2=74%,p<0.001,WMD=0.46, 95% CI: 0.12-0.80), and in type 2 diabetes (I2=90%,p<0.001,WMD=0.59, 95% CI: 0.28-0.90,p<0.001). In subgroup analysis by the study design, there was a correlation in cross-sectional study (I2=89%,p<0.001,WMD=0.42, 95% CI: 0.16-0.69,p≤0.003) and in case-control study (I2=83%,p<0.001,WMD=0.39, 95% CI: 0.14-0.64,p≤0.003). By different methods for detecting Helicobacter pylori, there was a correlation in the biopsy group (I2=83%,p<0.001,WMD=0.6, 95% CI: 0.11-1.09,p≤0.03) and in other groups of test methods (I2=87%,p<0.001,WMD=0.37, 95% CI: 0.17-0.56,p<0.001). Sensitivity analysis showed that our results were reliable, and no evidence of substantial publication bias was detected.Conclusion. The meta-analysis might indicate a correlation between Helicobacter pylori infection and glycated hemoglobin A levels in diabetes.

Diabetes, glycaemic control, and risk of COVID-19 hospitalisation: Population-based, prospective cohort study

“…We found evidence of a graded association between A1C and risk of COVID-19 in a large community-dwelling cohort. The accumulation of differentiated cytotoxic T cells have been linked to impaired glucose homeostasis in pre-clinical work [ 7 ], and associations between A1C and other types of infections have also been observed [ 8 , 9 ]. In several large primary care cohorts a range of infections were more frequent in people with diabetes with worse glycaemic control [ 10 , 11 ], which is consistent with our data.…”

Review: Extragastric diseases andHelicobacter pylori

“…The pooled OR was 1.27 (95% CI, 1.11‐1.45; P = .0001), significant only among patients with type 2 DM (OR, 1.43; 95% CI, 1.11‐1.85) and more evident in Asians 8 . In agreement, a meta‐analysis including 35 studies with 4401 diabetic patients, showed that glycated haemoglobin A (HbA) levels were significantly higher in patients with H pylori infection compared to uninfected subjects (weighted mean difference = 0.50; 95% CI, 0.28‐0.72; P < .001), without any difference related to the type of DM or study design 9 …”

“…8 In agreement, a meta-analysis including 35 studies with 4401 diabetic patients, showed that glycated haemoglobin A (HbA) levels were significantly higher in patients with H pylori infection compared to uninfected subjects (weighted mean difference = 0.50; 95% CI, 0.28-0.72; P < .001), without any difference related to the type of DM or study design. 9 In Saudi Arabia, a study included 212 type 2 DM patients aged ≥ 40 years and 209 age-matched non-diabetic subjects. H pylori prevalence was significantly higher in overweight and obese non-diabetic subjects (P = .013).…”

Helicobacter pylori infection: Beyond gastric manifestations

“…Besides that, the H. pylori infection not only increase the risk of DM, but it also impairs the satisfactory control of glycemic levels in DM patients. A meta-analysis that included 35 studies observed that the glycated hemoglobin A levels were significantly higher in H. pylori -positive patients when compared to H. pylori negative individuals (weighted mean difference 0.50, 95%CI: 0.28-0.72, P < 0.001)[ 135 ]. However, the fact that these studies do not take into account other factors that influence the glycemic control, such as obesity index and smoking status, constitute an important limitation[ 134 , 135 ].…”

“…A meta-analysis that included 35 studies observed that the glycated hemoglobin A levels were significantly higher in H. pylori -positive patients when compared to H. pylori negative individuals (weighted mean difference 0.50, 95%CI: 0.28-0.72, P < 0.001)[ 135 ]. However, the fact that these studies do not take into account other factors that influence the glycemic control, such as obesity index and smoking status, constitute an important limitation[ 134 , 135 ]. Among the hypothesis on how does H. pylori increases the risk of DM, it is believed that the increased cytokine production leads to the phosphorylation of serine residues from the insulin receptor substrate, whose linkage with insulin receptors turns deficient[ 136 ].…”