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Diabetes Possibly Linked to H. pylori Gastric Infection

Posted Mar 29 2012 12:00am

H. pylori is now recognized as a major causal agent of chronic gastritis, an indolent process. Although the pathogen is present in almost all such patients, a small proportion of them may also develop diseases such as peptic ulcer, gastric carcinoma, or primary gastric-mucosa-associated lymphoma (see: Variants of the 3′ Region of the cagA Gene in Helicobacter pylori Isolates from Patients with Different H. pylori-Associated Diseases ). A recent report also linked H. pylori to high levels of HbA1c (see: Diabetes link to H. pylori bacteria: new NYU Langone study ). Below is an excerpt from the article:

A new study...reveals that the presence of Helicobacter pylori (H. pylori) bacteria is associated with elevated levels of glycosylated hemoglobin (HbA1c), an important biomarker for blood glucose levels and diabetes. The association was even stronger in obese individuals with a higher Body Mass Index (BMI)....There have been several studies evaluating the effect of the presence of H. pylori on diabetes outcomes, but this is the first to examine the effect on HbA1c, an important, objective biomarker for long-term blood sugar levels....“Obesity is an established risk factor for diabetes and it is known that high BMI is associated with elevated HbA1c. Separately, the presence of H. pylori is also associated with elevated HbA1c,” said [one of the study authors] “We hypothesized that having both high BMI and the presence of H. pylori would have a synergistic effect, increasing HbA1c even more than the sum of the individual effect of either risk factor alone. We now know that this is true.” H. pylori lives in the mucous layer lining the stomach where it persists for decades. It is acquired usually before the age of 10, and is transmitted mainly in families....[P]revious studies have confirmed the bacterium’s link to stomach cancer and elucidated genes associated with its virulence, particularly a gene called cagA. Regarding H. pylori‘s association with elevated HbA1c,[the study authors] believe the bacterium may affect the levels of two stomach hormones that help regulate blood glucose, and they suggest that eradicating H. pylori using antibiotics in some older obese individuals could be beneficial. More research will be needed to evaluate the health effects of H. pylori and its eradication among different age groups and in relation to obesity status, the authors noted.

To keep everyone on the same page, here is a brief description of HbA1c (see: Glycated hemoglobin ):

In the normal 120-day lifespan of the red blood cell, glucose molecules react with hemoglobin, forming glycosolated hemoglobin. In individuals with poorly controlled diabetes, the quantities of these glycosolated hemoglobins are much higher than in healthy people. Once a hemoglobin molecule is glycosolated, it remains that way. A buildup of glycosolated hemoglobin within the red cell, therefore, reflects the average level of glucose to which the cell has been exposed during its life-cycle. Measuring glycosolated hemoglobin assesses the effectiveness of therapy by monitoring long-term serum glucose regulation. The HbA1c level is proportional to average blood glucose concentration over the previous four weeks to three months.

This is an interesting story about the pathophysiology of the gastric mucosa. Clearly, a chronic infection of the mucosa with H. pylori causes a number of mucosal "systems" to go awry leading to gastric ulcers and adenocarcinoma/lyphoma in a small percentage of patients. Infection also causes an elevation of HbA1c which is even worse in obese patients. We also know that weight loss can ameliorate or cure diabetes. Bariatric surgery can have a similar effect, even prior to any weight loss (see: Bariatric Surgery Cures Adult-Onset Diabetes; Is This a Problem? ).The possibility now exists that the bacterium may affect the levels of two stomach hormones that help regulate blood glucose. Hence the elevated HbA1c with infection. I am looking forward to research that might indicate that antibiotic treatment of the infection can cure diabetes as well as gastric ulcers.

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