Short-term Effect of Hypergastrinemia Following Esomeprazole Treatment On Well-Controlled Type 2 Diabetes Mellitus: A Prospective Study.

Objective: Proton pump inhibitor (PPI) drugs reduce gastric acid secretion and lead to an increase in serum gastrin levels. Many preclinical and some clinical researches have established some positive effects of gastrin or PPI therapy on glucose regulation. The aim of this study was to prospectively investigate the short term effects of esomeprazole on glycaemic control in patients with type 2 diabetes mellitus. In addition, the presence of an association between this effect and gastrin levels was evaluated. Methods: Thirty-two subjects with type 2 diabetes mellitus were enrolled and grouped as intervention (n=16) and control (n=16). The participants in the intervention group were prescribed 40 mg of esomeprazole treatment for three months. At the beginning of the study and at the 3rd month, HbA1c level (%) and gastrin levels (pmol/L) of participants were assessed. Then, the groups were compared in terms of their baseline and 3rd month values. Results: In the intervention group, the mean gastrin level increased significantly from 34.3 +/- 14.4 pmol/L to 87.4 +/- 43.6 pmol/L (p<0.001). The mean HbA1c level was similar to the pre-treatment level (6.3 +/- 0.7% vs. 6.4 +/- 0.9%, p=0.441). There were no statistically significant differences in all parameters of the control group. The majority of individuals were on metformin monotherapy (65.6 %). The subgroup analysis of metformin monotherapy revealed that, in intervention group, there was a significant increase in gastrin levels (39.9 +/- 12.6 vs. 95.5 +/- 52.5, p=0.026), but the HbA1c levels did not change (6.0 +/- 0.4 % vs. 5.9 +/- 0.6 %, p=0.288); and in control group, gastrin levels did not change (37.5 +/- 26.7 vs. 36.1 +/- 23.3, p=0.367), but there was an increase in HbA1c levels (6.1 +/- 0.50 vs. 6.4 +/- 0.60, p=0.01). Conclusion: Our study demonstrates that esomeprazole has no extra benefit for the controlled diabetic patient in three months. However, in only the metformin-treated subgroup, esomeprazole may prevent the rise in HbA1c level.