Risk stratification for proton pump inhibitor-associated type 2 diabetes: a population-based cohort study

We have recently reported in GUT that regular proton pump inhibitor (PPI) use was associated with a 24% increased risk of type 2 diabetes mellitus (T2DM).1 This was the first study demonstrating an association between PPIs and diabetes. However, all included participants were healthcare professionals and the findings have not been verified in general populations. Additionally, investigation of subgroups at high absolute risk of diabetes among PPI users is still lacking. Because the absolute effects of interventions tend to increase with baseline risk, individualised treatment based on the patients’ underlying risk may confer benefits and reduce harms. Such risk stratification strategy had been applied to select patients for antihypertensive and statin therapy.2 3 In the present study, we conducted a prospective analysis of the UK-Biobank to (1)confirm the association between PPI use and T2DM in general population and (2) to investigate which population groups may have high net risk. We included participants free of diabetes from the UK Biobank.4 Regular use of PPIs was defined as taking PPIs in most days of week for the last 4 weeks. T2DM cases were identified from different data sources (primary care, hospital admissions, self-report and death register). We evaluated hazard ratios (HRs) adjusting for potential confounders. We calculated …