Association of Incidence of Acid-related Upper Gastrointestinal Disorders With GIycated Hemoglobin Level

• Published in: The journal of clinical endocrinology and metabolism Vol. 107; no. 6; p. e2563
• Main Authors: Tseng, Ping-Huei, Hung, Chi-Sheng, Tu, Chia-Hung, Chen, Chien-Chuan, Liao, Wan-Chung, Lee, Yi-Chia, Chiu, Han-Mo, Yang, Wei-Shiung, Wu, Ming-Shiang
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.06.2022
• Subjects: Analysis; Complications and side effects; Glycosylated hemoglobin; Hyperglycemia; Peptic ulcer; Taiwan
• ISSN: 0021-972X
• DOI: 10.1210/clinem/dgac062

Context: Previous cross-sectional studies show diabetes and higher levels of plasma hemoglobin A1 c (HbA1 c) are associated with a higher prevalence of gastrointestinal (GI) complications. However, whether the glycemic status is associated with incident acid-related upper GI disorders remains unclear. Objective: We aimed to determine the effect of hyperglycemia per se, in terms of HbA1 c, on the incidence of acid-related disorders. Methods: We analyzed consecutive subjects who had undergone repeated upper endoscopies as part of the health examinations at the NationalTaiwan University Hospital from 2005 to 2011. Acid-related endoscopic abnormalities were defined as erosive esophagitis (EE), Barrett's esophagus (BE), and peptic ulcer disease (PUD), which included gastric ulcers (GUs) and duodenal ulcers (DUs). All subjects were categorized by 3 tertiles of HbA1 c levels. We analyzed the occurrence of respective acid-related disorders during the follow-up period. Results: A total of 11 391 participants (mean HbA1c level 5.6 [+ or -] 0.7%) were enrolled in this longitudinal study. During the 38 426.3 person-years of follow-up (mean duration 3.37 [+ or -] 1.59 years), the incidence of EE, BE, GU, DU, PUD, and any acid-related disorders were 22.1 %, 0.5%, 4.5%, 8.6%, 12.3%, and 30.3%, respectively. The higher HbA1c level was associated with higher risk of disease incidents, except BE, during the follow-up (all log-rank P< .001). In the Cox regression analyses with confounding factors fully adjusted, the hazard ratios for EE, GU, DU, PUD, and acid-related disorders were 1.174, 1.339, 1.24, 1.24, and 1.186, respectively, for the third tertile of HbA1c (all P<.05). Conclusion: Higher HbA1c level was associated with a higher risk of acid-related upper GI endoscopic abnormalities. Efforts toward better glycemic control may help to prevent the development of late GI complications. Key Words: diabetes, HbA1c, erosive esophagitis, peptic ulcer, acid-related disorder