When metabolic disease rewrites infection biology: Long-term multiorgan consequences of Helicobacter pylori infection in diabetes

Figure 3 Proposed clinical algorithm for Helicobacter pylori management in patients with type 2 diabetes mellitus. A stepwise algorithm is proposed integrating: (1) Universal Helicobacter pylori screening at type 2 diabetes mellitus diagnosis; (2) Virulence genotyping (CagA/VacA) for risk stratification; (3) Early eradication with glycemic co-optimization; (4) Probiotic adjunction for microbiota resilience; and (5) Post-eradication multiorgan surveillance encompassing hepatic function, renal parameters, and HbA1c. H. pylori: Helicobacter pylori; T2DM: Type 2 diabetes mellitus; ALT: Alanine aminotransferase; UBT: Urea breath test; LFT: Liver function test; uACR: Urine albumin-to-creatinine ratio; eGFR: Estimated glomerular filtration rate.