Diabetes Increases Risk of Gastric Cancer After Helicobacter pylori Eradication: A Territory-Wide Study With Propensity Score Analysis

Diabetes Care. 2019 Sep;42(9):1769-1775. doi: 10.2337/dc19-0437. Epub 2019 Jul 11.


Objective: Whether diabetes mellitus (DM) increases risk of gastric cancer (GC) remains controversial because of inadequate adjustments for important risk factors, including Helicobacter pylori (HP) infection status, concomitant medication use, and cancer site. We investigated whether type 2 DM increased risk of GC in patients after they received treatment for HP infection.

Research design and methods: This was a territory-wide cohort study of patients aged ≥45 years who had received clarithromycin-based triple therapy for HP infection between 2003 and 2012 in Hong Kong. Data were retrieved from a public electronic health database. Observation started from receipt of therapy for HP infection to GC diagnosis, death, or the end of the study (December 2015). Exclusion criteria included type 1 DM, GC diagnosed within the 1st year of HP therapy, prior GC or gastrectomy, and retreatment for HP infection. The adjusted hazard ratio (aHR) of GC with type 2 DM was calculated by using a Cox model that adjusted for 20 covariates (age, sex, comorbidities, and medications) through propensity score regression.

Results: During a median follow-up of 7.1 years (interquartile range 4.8-9.3 years), 153 of 46,460 patients (0.33%) developed GC at a median age of 72.4 years. Type 2 DM was associated with an increased risk of GC (aHR 1.73 [95% CI 1.08-2.79]). Stratified analysis showed an increase in risk for cardia cancer only (aHR 3.40 [95% CI 1.45-7.97]) and in those with suboptimal DM control (time-weighted mean HbA1c ≥6.0% [42 mmol/mol]; aHR 1.68 [95% CI 1.07-2.63]).

Conclusions: Type 2 DM is associated with an increased risk of GC among patients in whom HP was eradicated, in particular gastric cardia cancer and in those with suboptimal DM control.

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Clarithromycin / therapeutic use
  • Cohort Studies
  • Diabetes Mellitus, Type 2 / microbiology*
  • Female
  • Helicobacter Infections / complications*
  • Helicobacter Infections / drug therapy
  • Helicobacter pylori*
  • Hong Kong / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Propensity Score
  • Proportional Hazards Models
  • Risk Factors
  • Stomach Neoplasms / epidemiology*
  • Stomach Neoplasms / microbiology


  • Anti-Bacterial Agents
  • Clarithromycin