title: The use of proton pump inhibitors decreases the risk of diabetes mellitus in patients with upper gastrointestinal disease: A population-based retrospective cohort study.
abstract: OBJECTIVE
  The aim of this study was to investigate the effects of proton pump inhibitors (PPIs) on the risk of diabetes mellitus (DM) among patients with upper gastrointestinal disease (UGID).
  
  
  METHODS
  This was a retrospective cohort study with a follow-up period of 5 years. We identified 388,098 patients who were diagnosed with UGID between 2000 and 2006 from the Longitudinal Health Insurance Database of the Taiwan National Health Insurance program. We used Cox proportional hazard ratio (HR) to compare the risk of DM between UGID patients received PPIs and those did not receive PPIs. HRs were adjusted for possible confounders, including age, sex, hypertension, gout and/or hyperuricemia, coronary artery disease, stroke, pancreatitis, hyperlipidemia, obesity, H2-blocker use, and clozapine or olanzapine use. The dose-related effects of PPIs on the risk of DM were evaluated according to the defined daily dose (DDD).
  
  
  RESULTS
  The adjusted HR was 0.80 (95% CI, 0.73-0.88) for the study group (UGID patients with PPIs) compared with comparison group I (UGID patients without PPIs). Among patients who used PPIs, those older than 60 years of age had a lower risk of DM (HR, 0.73; 95% CI, 0.63-0.83) than those younger than 40 years. Additionally, the effect of PPIs was significantly dose-dependent (P for trend <0.001). Patients with UGID who received >540 DDDs of PPIs exhibited the greatest reduction in the risk of DM.
  
  
  CONCLUSIONS
  Our results demonstrated a decreased risk of DM in UGID patients who used PPIs; the risk appeared to be significantly dose-dependent.
authors.affiliation: Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei Department of Laboratory Medicine, Taipei Medical University Hospital, Taipei School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei Department of Neurology, Cathy General Hospital, Sijhih Branch, New Taipei City Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Hsiu-Chen
authors.initials: HC
authors.lastname: Lin
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Hsiao
authors.forename: Hsiu-Li
authors.initials: HL
authors.lastname: Lin
authors.forename: Yow-Shieng
authors.initials: YS
authors.lastname: Uang
authors.forename: Hui-Wen
authors.initials: HW
authors.lastname: Cheng
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.forename: Li-Hsuan
authors.initials: LH
authors.lastname: Wang
mesh_terms: D003920:Diabetes Mellitus / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology
chemical_list: D054328:Proton Pump Inhibitors