Proton pump inhibitors (PPIs) are one of the most commonly used drugs in all adult age categories. Long-term use of these drugs has been associated with metabolic disturbances, including an increased risk of diabetes.

This study aimed to evaluate the prevalence of diabetes and associated metabolic alterations in non-diabetic individuals using PPIs for prolonged duration.

This cross-sectional study was conducted at the tertiary care hospital between January and September 2024. Participants aged 18 years or older, with a history of PPI use for over 1 year and without diabetes, were recruited based on predefined inclusion and exclusion criteria. Demographic data, PPI usage patterns (type, dose, and duration), and blood samples were collected. Metabolic parameters, including fasting blood sugar (FBS)/RBS, HbA1C, serum gastrin, and C-Peptide, were analyzed. We determined the prevalence rates of diabetes and prediabetes, along with the associated metabolic alterations.

The study included 250 participants, with a mean age of 50.3 ± 13.7 years, predominantly female (65.6%). The prevalence of diabetes and prediabetes in the study population was 7.2% and 38.8% based on HbA1c and 11.1% and 37.7% based on FBS criteria. Most participants used PPIs at a frequency of seven doses per week (67.2%) for 1–5 years (82.8%). Participants taking 7 doses per week had significantly higher FBS levels (109.00 ± 25.46 mg/dL) compared to those taking < 7 doses per week (98.74 ± 16.57 mg/dL; p = 0.038). C-Peptide levels were significantly lower in the 7 doses per week group (p = 0.046). The duration of PPI use and number of doses showed no significant association with metabolic parameters.

The prevalence of diabetes among long-term PPI users was 7.2 to 11.1%. Prolonged PPI use was associated with altered FBS and C-Peptide levels, suggesting potential glucose dysregulation. Although the observed metabolic alterations are modest, they highlight the importance of careful monitoring and judicious use of PPIs. Further prospective studies are warranted to validate these findings and explore underlying mechanisms.