Does antibiotic exposure increase risk for T2D?

  • Davis PJ & al.
  • Prim Care Diabetes
  • 16 Jul 2018

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Consider potential for increased diabetes risk when deciding whether to prescribe antibiotics.

Why this matters

  • Antibiotics may raise diabetes risk via microbiome perturbation and subsequent effect on inflammation, metabolic, and pancreatic functions.

Study design

  • Retrospective cohort study of 14,361 US veterans in primary care (2004-2014) without prior diabetes diagnosis, of whom 9.8% were diagnosed with diabetes in 3.4 years’ follow-up.
  • Funding: New York University; US Department of Veterans Affairs.

Key results

  • After adjustments, incident diabetes risks with prescriptions >6 months before diabetes diagnosis were increased for (HR [95% CI]):
    • Any antibiotic: 1.13 (1.01-1.26),
    • Antifungals: 1.24 (1.02-1.51),
    • Macrolides: 1.12 (1.00-1.25),
    • Penicillin: 1.15 (1.01-1.30),
    • Quinolones: 1.13 (1.01-1.27), and
    • Tetracycline: 1.25 (1.06-1.48).
  • Diabetes risk increased with each 1-unit increase in cumulative number of courses for (HR [95% CI]):
    • Cephalosporins: 1.17 (1.04-1.31),
    • Macrolides: 1.08 (1.03-1.13), and
    • Penicillin: 1.05 (1.02-1.07).
  • By mean daily dose, increased diabetes risk was observed for (HR [95% CI]):
    • Antifungals: 1.02 (1.01-1.04),
    • Cephalosporins: 1.70 (1.51-1.92),
    • Macrolides: 1.27 (1.22-1.33),
    • Penicillin: 1.07 (1.05-1.09),
    • Quinolones: 1.36 (1.30-1.42),
    • Tetracycline: 1.39 (1.23-1.58), and
    • Sulfonamide: 1.05 (1.02-1.08).

Limitations

  • Predominantly white, male, older population.
  • Data limited to Veterans Affairs outpatient records, only filled prescriptions.
  • No information on antibiotic indication.

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