Background: Type 1 diabetes is a multifactorial, immune mediated disease whose incidence has been increasing worldwide. These changes in prevalence cannot be explained by genetic susceptibility alone and several lifestyle changes have been linked to the rising incidence including obesity, diet and mode of delivery. Many of these environmental factors influence the composition of the gut microbiome which interacts with the immune system as well as affects gut permeability, thus facilitating exposure to potentially diabetogenic antigens and possibly playing a role in initiating autoimmunity against islet cells. Acid suppressive medications have been linked to intestinal dysbiosis, however there is no data analyzing the role of acid suppressant use and development of type 1 diabetes.
Methods: This retrospective study was conducted using the Explorys database, an open private cloud platform that electronically integrates non-identified patient data used by major health systems comprising of almost 50 million patients. We queried the database for children who received acid suppressive medications (proton pump inhibitors or H2- receptor blockers) between 0 to 4 years of age. Patients who received acid suppressants served as cases and patients who did not receive the medications served as controls. Then we compared the number of patients who were diagnosed with Type 1 diabetes between 5 and 24 years of age in both the groups. We used Type 1 diabetes and included 8 other sub-diagnosis based on SNOMED (Systematized Nomenclature of Medicine - Clinical Terms) classification of diseases. We excluded patients with a diagnosis of neonatal diabetes. Both groups were controlled for obesity and vitamin D deficiency. Data was analyzed using SPSS software.
Results: The database comprises data of almost 10.3 million patients between ages 5 to 24. 40840 of these patients had a diagnosis of type 1 diabetes in the Explorys database. With the large sample size, we assumed the subjects to have equal risk of developing type 1 diabetes in both the exposed and unexposed groups. Exposure to acid suppressive medications before the age of 4 was not significantly associated with a future risk of developing type 1 diabetes (OR =1.09; CI 0.99 to 1.2, P value=0.09).
Conclusion: Treatment with acid suppressive medications such as proton pump inhibitors and H2- receptors blockers during infancy and early childhood is not significantly associated with higher odds of developing type 1 diabetes.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology