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Systemic use of antibiotics and risk of diabetes in adults: A nested case‐control study of Alberta's Tomorrow Project
Author(s) -
Ye Ming,
Robson Paula J.,
Eurich Dean T.,
Vena Jennifer E.,
Xu JianYi,
Johnson Jeffrey A.
Publication year - 2018
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13163
Subject(s) - medicine , diabetes mellitus , confounding , nested case control study , antibiotics , odds ratio , logistic regression , cohort study , cohort , observational study , case control study , environmental health , intensive care medicine , endocrinology , microbiology and biotechnology , biology
Aims Previous observational studies using administrative health records have suggested an increased risk of diabetes with use of antibiotics. However, unmeasured confounding factors may explain these results. This study characterized the association between systemic use of antibiotics and risk of diabetes in a cohort of adults in Canada, accounting for both clinical and self‐reported disease risk factors. Materials and Methods In this nested case‐control study, we used data from Alberta's Tomorrow Project (ATP), a longitudinal cohort study in Canada, and the linked administrative health records (2000‐2015). Incident cases of diabetes were matched with up to 8 age and sex‐matched controls per case. Conditional logistic regression was used to examine the association between antibiotic exposures and incident diabetes after sequentially adjusting for important clinical and lifestyle factors. Results This study included 1676 cases of diabetes and 13 401 controls. Although 17.9% of cases received more than 5 courses of antibiotics, compared to 13.8% of controls ( P < .0001), the association between antibiotic use and risk of diabetes was progressively reduced as important clinical and lifestyle factors were accounted for. In fully adjusted models, compared to participants with 0 to 1 courses of antibiotics, participants receiving more antibiotics had no increased risk of diabetes [Odds Ratio, 0.97 (0.83‐1.13) for 2 to 4 courses and 0.98 (0.82‐1.18) for ≥5 courses]. Conclusions After adjustment for clinical and difficult‐to‐capture lifestyle data, we found no association between systemic use of antibiotics and risk of diabetes. Our results suggest that those positive associations observed in previous studies using only administrative records might have been confounded.