title: The effect of past antibiotic exposure on diabetes risk.
abstract: OBJECTIVE
  Gut microbiota influence metabolic pathways related to the pathogenesis of obesity, insulin-resistance and diabetes. Antibiotic therapy can alter the microbiota, and is commonly used in western countries. We sought to evaluate whether past antibiotic exposure increases diabetes risk.
  
  
  METHODS
  We conducted a nested case-control study using a large population-based database from the UK. The cases were defined as those with incident diagnosis of diabetes. For every case, four eligible controls matched on age, sex, practice-site, and duration of follow-up before index-date were selected using incidence-density sampling. Exposure of interest was antibiotic therapy >1 year before index-date. Odds ratios (ORs) and 95% CIs were estimated using conditional logistic regression. The risk was adjusted for BMI, smoking, last glucose level, and number of infections before index-date, as well as past medical history of coronary artery disease and hyperlipidaemia.
  
  
  RESULTS
  The study included 208 002 diabetic cases and 815 576 matched controls. Exposure to a single antibiotic prescription was not associated with higher adjusted diabetes risk. Treatment with two to five antibiotic courses was associated with increase in diabetic risk for penicillin, cephalosporins, macrolides and quinolones with adjusted OR ranging from 1.08 (95% CI 1.05-1.11) for penicillin to 1.15 (95% CI 1.08-1.23) for quinolones. The risk increased with the number of antibiotic courses and reached 1.37 (95% CI 1.19-1.58) for more than 5 courses of quinolones. There was no association between exposure to anti-virals and anti-fungals and diabetes risk.
  
  
  CONCLUSIONS
  Exposure to certain antibiotic groups increases diabetes risk.
authors: Perelman School of Medicine at the University of PennsylvaniaPhiladelphia, Pennsylvania, USAThe Integrated Cancer Prevention CenterTel-Aviv Sourasky Medical Center, Tel-Aviv, IsraelTel-Aviv UniversityTel-Aviv, Israel Perelman School of Medicine at the University of PennsylvaniaPhiladelphia, Pennsylvania, USAThe Integrated Cancer Prevention CenterTel-Aviv Sourasky Medical Center, Tel-Aviv, IsraelTel-Aviv UniversityTel-Aviv, Israel Perelman School of Medicine at the University of PennsylvaniaPhiladelphia, Pennsylvania, USAThe Integrated Cancer Prevention CenterTel-Aviv Sourasky Medical Center, Tel-Aviv, IsraelTel-Aviv UniversityTel-Aviv, Israel.
authors: Ben
authors: B
authors: Boursi
authors: Perelman School of Medicine at the University of PennsylvaniaPhiladelphia, Pennsylvania, USAThe Integrated Cancer Prevention CenterTel-Aviv Sourasky Medical Center, Tel-Aviv, IsraelTel-Aviv UniversityTel-Aviv, Israel.
authors: Ronac
authors: R
authors: Mamtani
authors: Perelman School of Medicine at the University of PennsylvaniaPhiladelphia, Pennsylvania, USAThe Integrated Cancer Prevention CenterTel-Aviv Sourasky Medical Center, Tel-Aviv, IsraelTel-Aviv UniversityTel-Aviv, Israel.
authors: Kevin
authors: K
authors: Haynes
authors: Perelman School of Medicine at the University of PennsylvaniaPhiladelphia, Pennsylvania, USAThe Integrated Cancer Prevention CenterTel-Aviv Sourasky Medical Center, Tel-Aviv, IsraelTel-Aviv UniversityTel-Aviv, Israel.
authors: Yu-Xiao
authors: YX
authors: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D002511:Cephalosporins / Q000009:adverse effects*; D003922:Diabetes Mellitus, Type 1 / Q000139:chemically induced* / Q000453:epidemiology; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018942:Macrolides / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000009:adverse effects*; D015363:Quinolones / Q000009:adverse effects*; D012306:Risk; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D018942:Macrolides; D010406:Penicillins; D015363:Quinolones