Impact of Cytotoxin-Associated Gene Product-A Positive Helicobacter Pylori Strains on Micro-albuminuria in Type 2 Diabetes

Abstract

Introduction: Available data on the possible association between Helicobacter Pylori (H. pylori) infection and diabetes mellitus (DM) are contradictory. The prevalence of cytotoxin associated gene product A (cagA) positive H. pylori is high in Egypt. This study aims to examine its association with type 2 DM, and its effect on glycemic control and the occurrence of microalbuminuria.
Methods: The study involved 98 dyspeptic type 2 diabetic patients and 102 dyspeptic non-diabetic subjects who underwent upper gastrointestinal tract endoscopy in Zagazig university hospital. H. pylori infection was diagnosed by histopathology and/or culture. The presence of cagA positive strains was confirmed by polymerase chain reaction (PCR) and gel electrophoresis. Fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c) and urinary albumin excretion ratio (UAER) were compared between infected and non-infected diabetic patients.
Results: Diabetic patients had similar age and gender distribution but significantly higher body mass index (BMI) compared to controls. The prevalence of H. pylori infection (54.1% versus 56.9%, P = 0.3) and the prevalence of cagA positive H. pylori strains (40.8% versus 36.3%, P =0.1) were not significantly different between the two groups. Diabetic patients infected with cagA positive H. pylori strains had higher mean FBS (199±22 versus 163±20, P=0.00), higher mean HbA1c (8.6±0.8 versus 6.3±0.8, P=0.00) and higher rate of microalbuminuria (67.5% versus 10.3%, P=0.00) than non infected diabetic patients.
Conclusion: H. pylori infection with cagA positive strains was similarly common in dyspeptic diabetic patients and controls. It was associated with poorer glycemic control and higher rates of microalbuminuria in diabetic subjects.

Key words: cagA positive strains; Diabetes mellitus; Helicobatcer pylori; Microalbuminuria