title: The Influence of Proton-Pump Inhibitors on Glycemic Control: A Systematic Review of the Literature and a Meta-Analysis.
abstract: OBJECTIVE
  Proton-pump inhibitors (PPIs) have shown antihyperglycemic effects by stimulating insulin secretion. The aim of this study was to analyze the effect of PPIs on glucose metabolism in general and any potential antidiabetes effects in patients with type 2 diabetes.
  
  
  METHODS
  A systematic search was conducted in MEDLINE, Embase, Cochrane and PubMed. Studies using PPIs as interventions and reporting glucose levels, glycated hemoglobin (A1C) levels and insulin levels were selected. Weighted-mean differences (WMDs) were calculated for all outcomes. A random-effects model was used for moderate and high heterogeneity and a fixed-effects model for low heterogeneity data.
  
  
  RESULTS
  The research included 9 studies have involving 320 patients in total. Among patients with type 2 diabetes, those exposed to PPIs did not see significant reductions in A1C levels; WMD -0.36, 95% confidence interval (CI) -0.87, 0.15; p=0.17. Pantoprazole resulted in a statistically significant reduction in A1C levels in patients with type 2 diabetes when compared to control interventions; WMD -0.93, 95% CI -1.49, -0.37; p=0.001. There was no statistically significant difference in other outcomes (p≥0.05).
  
  
  CONCLUSIONS
  This meta-analysis demonstrates that PPIs, in general, do not decrease A1C levels in patients with type 2 diabetes. However, pantoprazole produced significant reductions in A1C levels in patients with type 2 diabetes. Given the limitations and the presence of bias in the primary studies, larger and better-quality studies are warranted.
authors.affiliation: Department of Family Medicine, McGill University, Montreal, Quebec, Canada. Electronic address: juan.gomezizquierdo@mail.mcgill.ca.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Gómez-Izquierdo
authors.affiliation: Division of Endocrinology, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Oriana Hoi Yun
authors.initials: OHY
authors.lastname: Yu
mesh_terms: D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy*; D038321:Glycemic Index / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D054328:Proton Pump Inhibitors
keywords: antidiabetes medication; antidiabétique; diabetes; diabetes treatment; diabète; glucose; glycated hemoglobin; hémoglobine glyquée; inhibiteur de la pompe à protons; proton-pump inhibitor; traitement du diabète