IMPACT OF LONG-TERM USE OF PROTON PUMP INHIBITOR ON GLYCEMIC CONTROL IN ADULT PATIENT WITH T2DM WHO SUFFER FROM HEARTBURNING: SYSTEMIC REVIEW

Abstract

Background: Type 2 Diabetes Mellitus (T2DM) and gastroesophageal reflux disease frequently coexist, leading to prolonged proton pump inhibitor (PPI) use. However, the impact of long-term PPI therapy on glycemic control remains unclear due to conflicting evidence. This systematic review aimed to evaluate the effect of long-term PPI use on glycemic control in adult T2DM patients with heartburn.

Methods: A systematic review was conducted following PRISMA guidelines. A comprehensive literature search was performed in PubMed and reference lists up to 2024. Eligible studies included observational designs (cohort, case-control, cross-sectional) and randomized controlled trials (RCTs) involving adults with T2DM and heartburn, comparing long-term PPI use (≥12 weeks) versus no or short-term use. Outcomes included HbA1c, fasting plasma glucose (FPG), and diabetes incidence. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the Newcastle-Ottawa Scale and JBI checklists. A narrative synthesis was conducted.

Results: Ten studies (approximately 145,000 patients) met the inclusion criteria. Short-term PPI use (≤6 months), particularly pantoprazole, was associated with modest HbA1c reductions (0.2%–0.8%). However, five studies (50%) reported no significant glycemic changes with long-term use (>1 year). Notably, prolonged PPI use (>2 years) was associated with a 24% increased risk of new-onset diabetes (OR 1.24; 95% CI 1.15–1.34) in one large case-control study. Overall, the evidence indicated that PPIs produce no clinically significant or sustained glycemic improvement, with long-term use showing neutral to potentially adverse metabolic effects.

Conclusion: Long-term PPI use does not provide consistent or clinically meaningful improvements in glycemic control in T2DM patients with heartburn. While short-term therapy may yield transient, modest benefits, prolonged use offers no sustained advantage and may carry metabolic risks. PPIs should be prescribed based on gastrointestinal indications, not for glycemic management.