Department of Endocrinology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
Department of Neurology, Shin Kong Wu Huo-Shih Memorial Hospital, Taipei, Taiwan.
BMC Public Health. 2023 Sep 12;23(1):1772. doi: 10.1186/s12889-023-16689-2.
The incidence of type 2 diabetes mellitus has risen globally, from 108 million cases in 1980 to 422 million cases in 2014. Although controlling glycemic levels in patients with diabetes is crucial, insulin and sulfonylureas can cause hypoglycemic episodes and even potentially fatal events such as comas, seizures, life-threatening arrhythmias, and myocardial infarctions. Several antibiotics have been documented to cause hypoglycemic episodes; the use of antibiotics along with insulin or sulfonylureas might further increase the risk of hypoglycemia. Therefore, researchers must determine which antibiotics carry a risk of inducing severe hypoglycemic events. The prevalence of H. pylori infection remains high in most countries, and the infection is often treated with triple therapy involving amoxicillin, clarithromycin, and a proton pump inhibitor (PPI). Several case reports have reported that hypoglycemia can occur when used with patients who also take diabetes medication. Therefore, we hypothesized that patients with diabetes have an increased risk of hypoglycemic episodes when being treated with triple therapy for H. pylori infection. By analyzing medical records from Taiwan's National Health Insurance Research Database, we found a significant association between hypoglycemia and triple therapy treatment for diabetic patients with peptic ulcer disease. Prescribing triple therapy to patients with diabetes and peptic ulcers significantly increased the risk of a hypoglycemic episode (adjusted odds ratio [aOR] = 1.75, 95% confidence interval [CI]: 1.64 to 1.88, P < 0.001). Similarly, the highest aOR (5.77, 95% CI 4.82 to 6.92) was found in patients with diabetes and peptic ulcers who had hypoglycemic episodes within 30 days after triple therapy treatment. Many patients with diabetes require H.pylori eradication for peptic ulcer treatment, and vigilance toward the risk of hypoglycemia in this population is thus necessary.
2 型糖尿病的发病率在全球范围内上升，从 1980 年的 1.08 亿例上升到 2014 年的 4.22 亿例。尽管控制糖尿病患者的血糖水平至关重要，但胰岛素和磺酰脲类药物可导致低血糖发作，甚至可能导致昏迷、癫痫发作、危及生命的心律失常和心肌梗死等潜在致命事件。已有文献记载几种抗生素可引起低血糖发作；与胰岛素或磺酰脲类药物一起使用抗生素可能会进一步增加低血糖的风险。因此，研究人员必须确定哪些抗生素有引发严重低血糖事件的风险。大多数国家的幽门螺杆菌感染仍然很高，感染通常采用三联疗法治疗，包括阿莫西林、克拉霉素和质子泵抑制剂（PPI）。有几项病例报告称，当与同时服用糖尿病药物的患者一起使用时，会发生低血糖。因此，我们假设患有糖尿病的患者在接受三联疗法治疗幽门螺杆菌感染时发生低血糖发作的风险增加。通过分析来自台湾全民健康保险研究数据库的病历，我们发现糖尿病患者接受三联疗法治疗消化性溃疡时与低血糖之间存在显著关联。给患有糖尿病和消化性溃疡的患者开三联疗法显著增加了低血糖发作的风险（调整后的优势比[aOR] = 1.75，95%置信区间[CI]：1.64 至 1.88，P < 0.001）。同样，在接受三联疗法治疗后 30 天内发生低血糖的糖尿病和消化性溃疡患者中，aOR 最高（5.77，95%CI 4.82 至 6.92）。许多糖尿病患者需要根除幽门螺杆菌以治疗消化性溃疡，因此必须警惕此类人群发生低血糖的风险。
