title: Is Helicobacter pylori infection associated with glycemic control in diabetics?
abstract: OBJECTIVE
  To investigate whether Helicobacter pylori (H. pylori) infection is associated with glycemic control and whether hyperglycemia is modified by eradication therapy.
  
  
  METHODS
  The databases of PubMed, Cochrane Library, Chinese BioMedicine Web Base and Chinese Science and Technology Journals were searched from inception to June 2014. Studies examining the association between H. pylori infection and glycemic control and/or the effect of eradication treatment on glycemic control in diabetic humans were eligible for inclusion. Meta-analyses were conducted using the Review Manager software version 5.2. The outcome measures are presented as weighed mean differences (WMDs) with 95% confidence intervals (CIs). Statistical heterogeneity was assessed by the Cochran Q test and the I(2) statistic.
  
  
  RESULTS
  A total of 21 relevant publications were identified. A meta-analysis of 11 studies with 513 patients with diabetes mellitus (DM) showed significantly lower glycosylated hemoglobin (HbA1c) levels in the H. pylori-negative than H. pylori-positive DM participants (WMD = 0.43, 95%CI: 0.07-0.79; P = 0.02). In children and adolescents with type 1 DM (T1DM), there was a positive association between H. pylori infection and HbA1c level (WMD = 0.35, 95%CI: 0.05-0.64; P = 0.02), but there was no difference in those with type 2 DM (T2DM, WMD = 0.51, 95%CI: -0.63-1.65; P = 0.38). A meta-analysis of six studies with 325 T2DM participants showed a significant difference in the fasting plasma glucose levels between H. pylori-positive and H. pylori-negative participants (WMD = 1.20, 95%CI: 0.17-2.23; P = 0.02). Eradication of H. pylori did not improve glycemic control in the T2DM participants in a three-month follow-up period (HbA1c decrease: WMD = -0.03, 95%CI = -0.14-0.08; P = 0.57; fasting plasma glucose decrease: WMD = -0.06, 95%CI: -0.36-0.23; P = 0.68). Glycemic control was significantly better in T1DM participants who were not reinfected than in those who were reinfected (HbA1c: WMD = 0.72, 95%CI: 0.32-1.13: P = 0.00).
  
  
  CONCLUSIONS
  H. pylori infection is associated with poorer glycemic control in T1DM patients, but eradication may not improve glycemic control in DM in a short-term follow-up period.
authors.affiliation: Yi-Ning Dai, Wei-Lai Yu, Hua-Tuo Zhu, Jie-Xia Ding, Chao-Hui Yu, You-Ming Li, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Yi-Ning
authors.initials: YN
authors.lastname: Dai
authors.affiliation: Yi-Ning Dai, Wei-Lai Yu, Hua-Tuo Zhu, Jie-Xia Ding, Chao-Hui Yu, You-Ming Li, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Wei-Lai
authors.initials: WL
authors.lastname: Yu
authors.affiliation: Yi-Ning Dai, Wei-Lai Yu, Hua-Tuo Zhu, Jie-Xia Ding, Chao-Hui Yu, You-Ming Li, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Hua-Tuo
authors.initials: HT
authors.lastname: Zhu
authors.affiliation: Yi-Ning Dai, Wei-Lai Yu, Hua-Tuo Zhu, Jie-Xia Ding, Chao-Hui Yu, You-Ming Li, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Jie-Xia
authors.initials: JX
authors.lastname: Ding
authors.affiliation: Yi-Ning Dai, Wei-Lai Yu, Hua-Tuo Zhu, Jie-Xia Ding, Chao-Hui Yu, You-Ming Li, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors.forename: Chao-Hui
authors.initials: CH
authors.lastname: Yu
authors.affiliation: Yi-Ning Dai, Wei-Lai Yu, Hua-Tuo Zhu, Jie-Xia Ding, Chao-Hui Yu, You-Ming Li, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors.forename: You-Ming
authors.initials: YM
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D016009:Chi-Square Distribution; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects / Q000472:pathogenicity*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D054328:Proton Pump Inhibitors; C517652:hemoglobin A1c protein, human
keywords: Diabetes mellitus; Eradication; Glycemic control; Helicobacter pylori; Meta-analysis; Reinfection