Diabetes Is an Independent Risk Factor for Peptic Ulcer Bleeding

A Nationwide Population-based Cohort Study

Yen-Ling Peng; Hsin-Bang Leu; Jiing-Chyuan Luo; Chin-Chou Huang; Ming-Chih Hou; Han-Chieh Lin; Fa-Yauh Lee


J Gastroenterol Hepatol. 2013;28(8):1295-1299. 

In This Article

Abstract and Introduction


Background and Aims Diabetic patients reportedly have a higher incidence of peptic ulcer disease. The aim of this study was to investigate if type II diabetic patients have higher risk of developing peptic ulcer bleeding (PUB) and to identify possible risk factors of PUB in diabetic patients.

Methods Using the National Health Insurance Research Database of Taiwan, records of 5699 type II diabetic patients and 11 226 age- and sex-matched non-diabetic patients in a 1:2 ratio were extracted for comparison from a cohort dataset of 1 000 000 randomly sampled subjects. Log-rank test was used to analyze differences in cumulative hazard of PUB between the two groups. Cox proportional hazard regressions were used to evaluate independent risk factors for PUB in all patients and identified risk factors of PUB in type II diabetic patients.

Results In a 7-year follow-up period, type II diabetic patients had significantly higher cumulative hazard of PUB than the controls (P < 0.001, log-rank test). By Cox proportional hazard regression analysis, diabetes was independently associated with increased risk of PUB (hazard ratio 1.44, 95% confidence interval 1.11–1.86; P < 0.001) after adjusting for age, sex, comorbidities (e.g. hypertension, coronary heart disease, heart failure, chronic renal disease, cirrhosis, and peptic ulcer disease), and ulcerogenic medication. Age, chronic renal disease, history of peptic ulcer disease, and use of non-steroidal anti-inflammatory drugs were risk factors for PUB in diabetic patients.

Conclusions Type II diabetic patients have significantly higher risk of PUB even after adjustments for possible confounding factors like age, sex, underlying comorbidities, and ulcerogenic medication.


Population-based cohort studies have shown that comorbidities such as cirrhosis, chronic obstructive pulmonary disease, and uremia have a higher incidence of peptic ulcer bleeding (PUB).[1–3] Diabetic patients have been found to have a higher incidence of peptic ulcer disease (PUD) than the non-diabetic population.[4] Animal studies show delayed gastric ulcer healing and aggravated gastric mucosal susceptibility to ulcerogenic drugs or stress in diabetic rats.[5–7]

Whether diabetes mellitus increases the risk of PUB still needs to be evaluated. This nationwide population-based study aimed to investigate the association between type II diabetes and PUB after adjusting for potential confounding factors like ulcerogenic medication and underlying comorbidity, and to identity independent risk factors for PUB in type II diabetic patients.