title: Diabetes is an independent risk factor for peptic ulcer bleeding: a nationwide population-based cohort study.
abstract: OBJECTIVE
  Diabetic patients reportedly have a higher incidence of peptic ulcer disease. The aim of this study was to investigate if type II diabetic patients have higher risk of developing peptic ulcer bleeding (PUB) and to identify possible risk factors of PUB in diabetic patients.
  
  
  METHODS
  Using the National Health Insurance Research Database of Taiwan, records of 5699 type II diabetic patients and 11,226 age- and sex-matched non-diabetic patients in a 1:2 ratio were extracted for comparison from a cohort dataset of 1,000,000 randomly sampled subjects. Log-rank test was used to analyze differences in cumulative hazard of PUB between the two groups. Cox proportional hazard regressions were used to evaluate independent risk factors for PUB in all patients and identified risk factors of PUB in type II diabetic patients.
  
  
  RESULTS
  In a 7-year follow-up period, type II diabetic patients had significantly higher cumulative hazard of PUB than the controls (P < 0.001, log-rank test). By Cox proportional hazard regression analysis, diabetes was independently associated with increased risk of PUB (hazard ratio 1.44, 95% confidence interval 1.11-1.86; P < 0.001) after adjusting for age, sex, comorbidities (e.g. hypertension, coronary heart disease, heart failure, chronic renal disease, cirrhosis, and peptic ulcer disease), and ulcerogenic medication. Age, chronic renal disease, history of peptic ulcer disease, and use of non-steroidal anti-inflammatory drugs were risk factors for PUB in diabetic patients.
  
  
  CONCLUSIONS
  Type II diabetic patients have significantly higher risk of PUB even after adjustments for possible confounding factors like age, sex, underlying comorbidities, and ulcerogenic medication.
authors.affiliation: Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Yen-Ling
authors.initials: YL
authors.lastname: Peng
authors.forename: Hsin-Bang
authors.initials: HB
authors.lastname: Leu
authors.forename: Jiing-Chyuan
authors.initials: JC
authors.lastname: Luo
authors.forename: Chin-Chou
authors.initials: CC
authors.lastname: Huang
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Hou
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Fa-Yauh
authors.initials: FY
authors.lastname: Lee
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology* / Q000209:etiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
keywords: comorbidities; non-steroidal anti-inflammatory drugs (NSAIDs); peptic ulcer bleeding (PUB); type II diabetes