Abstract
BACKGROUND: The etiology of type 2 diabetes mellitus (T2DM) is complex, with environmental factors playing a significant role in its pathophysiology. Nonsteroidal anti-inflammatory drugs usage and Helicobacter pylori infection are the two most frequent causes of peptic ulcer disease (PUD). The link between PUD and T2DM is unclear, and comprehensive analyses of anti-PUD medications' impact on T2DM risk, especially in Asian populations, are lacking. This study aimed to determine the relationship between PUD, anti-PUD medications, and the likelihood of developing T2DM. OBJECTIVES: Using a population-based cohort study conducted in Taiwan, we investigated the impact of PUD and anti-PUD medications on the risk of T2DM. DESIGN: This is a retrospective, population-based cohort study using the largest database used in Taiwan. METHODS: An 18-year follow-up period study was conducted on a cohort of patients with PUD diagnosed between 2001 and 2018 using the Taiwan National Health Insurance Research Database. The risk of PUD as well as anti-PUD medications use were examined using Cox proportional regression model. RESULTS: Based on multivariable Cox proportional hazards regression analysis, patients with PUD had a higher overall T2DM incidence (22.7 vs 21.3 per 1000 person-years) than patients without PUD. The adjusted hazard ratio was 1.12 (95% confidence interval = 1.10, 1.13). Patients with PUD have a higher risk of T2DM in both genders and age groups. Patients with anti-PUD medications, such as H2 receptor antagonists, proton-pump inhibitors, antibiotics, prostaglandin analogs, anticholinergics, and antacids usage, are associated with a lower risk of developing T2DM than those without. Patients with PUD who underwent surgery were found to have a higher risk of T2DM. CONCLUSION: Patients with PUD are more likely to develop T2DM. Nevertheless, patients receiving anti-PUD medications have a lower incidence of T2DM.