Helicobacter pylori and insulin resistance: time to do interventional studies

Helicobacter pylori and diabetes mellitus: a controversial relationship

Research on Helicobacter pylori (H. pylori), a pathogenic bacterium that is widespread among humans, is investigating the medical implications of the infection in many fields beyond gastroenterology. Because of the ubiquitous presence of the infection, there is an increasing interest in finding a relationship between this bacterium and diabetes mellitus (DM). It is not clear whether a significant relation between H. pylori and DM exists, whether the infection influences diabetes or vice versa, and the mechanisms underlying such a relationship. This review provides an analysis of new insights from studies published in more recent years. New research on this topic concentrated on the common pathogenic aspects between the bacterium and insulin resistance or autoimmunity, on the role of the bacterial infection in cardiovascular risk and whether the infection worsen glycemic outcomes in patients with DM. Research in this field still has to conclusively assess and explain the existence of a possible relationship between H. pylori and DM. Some studies have reached antithetic conclusions. Unless more robust data from studies using consistent research methods become available in the near future, people with diabetes should be compared to the general population when it comes to investigating and treating the presence of H. pylori.

Randomized, double-blind, placebo-controlled trial to evaluate the effect of Helicobacter pylori eradication on glucose homeostasis in type 2 diabetic patients

BACKGROUND AND AIMS

Literature data suggest an association between Helicobacter pylori infection and glucose homeostasis. However, a causative link between them has not been demonstrated yet. The aim of this study is to investigate the effect of H. pylori eradication on glucose homeostasis in patients with type 2 diabetes.

METHODS AND RESULTS

A randomized, double-blind, placebo-controlled trial was conducted to investigate the effect of H. pylori eradication on glucose homeostasis in 154 patients with type 2 diabetes and who tested positive for H. pylori infection (mean age (SD), 63.1 (8.1) years). Subjects were assigned to H. pylori eradication treatment or placebo. Metabolic and inflammatory parameters were measured in all subjects at baseline and 4 weeks after the treatment. H. pylori eradication led to an improvement in glucose homeostasis, measured by HOMA-IR (p < 0.001) and KITT (0 = 0.041), due to the decrease in fasting insulin levels (p = 0.004). The results also showed that lower levels of inflammatory parameters were present after eradication.

CONCLUSION

To our knowledge this is the first randomized, double blind, controlled study where the effect of H. pylori eradication on glucose homeostasis in subjects with type 2 diabetes has been investigated. Our findings demonstrate that H. pylori eradication improves glucose homeostasis in patients with type 2 diabetes through a decrease in pro-inflammatory factors.

TRIAL REGISTRATION NUMBER

ACTRN12609000255280 (https://www.anzctr.org.au/).