Association between Helicobacter Pylori Infection and Glycosylated Hemoglobin Levels in Dyspeptic Patients

Abstract

Background: Helicobacter pylori (H. pylori) infects roughly half of the world’s population[3]. Concurrently, the global burden of type 2 diabetes mellitus (T2DM) is rising, with over 529 million adults affected in 2021. Some studies suggest a link between chronic H. pylori infection and impaired glycemic control[1], but findings are inconsistent. This study evaluated whether H. pylori infection is associated with elevated glycated hemoglobin (HbA1c) levels in dyspeptic patients.

Materials and Methods: We conducted a hospital-based cross-sectional study at A.J. Institute of Medical Sciences (Mangalore) from August 2022 to February 2024. Forty-six adult patients (age ≥18 years) with dyspeptic symptoms undergoing elective gastroscopy were enrolled. Patients previously treated for H. pylori, on recent antibiotics or proton-pump inhibitors, with active GI bleeding or malignancy, or unwilling to consent were excluded. During endoscopy, gastric biopsies were taken for a rapid urease test (RUT) to detect H. pylori. Glycemic status was assessed by measuring HbA1c in all subjects. Patient data (age, sex, BMI, endoscopic findings) were recorded. Descriptive statistics summarized the data (mean ± SD for continuous variables, proportions for categorical data). The association between H. pylori status and glycemic control (HbA1c <6.5% vs ≥6.5%) was tested by chi-square analysis. A two-sided p<0.05 was considered significant.

Results: Of 46 participants (mean age 58.7±16.5 years; 63.0% male), 21.7% had pangastritis, 26.1% fundal gastritis, and 52.2% antral gastritis on endoscopy. Mean body mass index (BMI) was 23.7±2.4 kg/m²; 73.9% had BMI in the normal range (18.5–25 kg/m²), 26.1% were overweight (>25 kg/m²). Mean HbA1c was 7.32±1.27%; notably, 76.1% of subjects had HbA1c ≥6.5%. Rapid urease testing was positive for H. pylori in 24/46 (52.2%) patients. Importantly, H. pylori infection was significantly more frequent in patients with HbA1c ≥6.5%: 23 of 35 (65.7%) high-HbA1c patients were H. pylori-positive, versus only 1 of 11 (9.1%) with HbA1c <6.5% (χ²=10.8, p=0.001). In other words, a high HbA1c level was associated with a higher prevalence of H. pylori infection in this cohort.

Conclusion: In this dyspeptic adult population, H. pylori infection was common and was strongly associated with poor glycemic control. Patients with elevated HbA1c (>6.5%) had a significantly higher rate of H. pylori positivity. These findings support a possible bidirectional relationship, as suggested by recent studies[1][2]. Clinicians should be aware that elevated HbA1c may predispose to H. pylori infection (and vice versa), highlighting the importance of screening for and eradicating H. pylori in patients with diabetes or prediabetes.