Association Between Antibiotics Use and Diabetes Incidence: A Nationally Representative Cohort Among Koreans

Abstract Background Previous studies have reported that antibiotics could lead to diabetes, even after adjusting for confounding variables. This study aimed to determine the association between antibiotic use and diabetes incidence in a nationally representative cohort.MethodsThis retrospective cohort study included adults aged 40 years or older who were enrolled in the Korean National Health Insurance Service-Health Screening Cohort. (NHIS-HEALS). Antibiotic exposure was assessed from 2002 to 2005 and newly diagnosed diabetes mellitus was determined based on diagnostic codes and history of antidiabetic medication use from 2006 to 2015. Multivariate Cox proportional hazards model was used to assess the association between antibiotic use and diabetes incidence.ResultsThe mean age of the 201,459 study subjects was 53.2 years. People who used antibiotics for 90 or more days had a higher risk of diabetes (adjusted hazard ratio [aHR] 1.16, 95% confidence interval [CI] 1.07–1.26) compared to non-users. Those who used five or more classes of antibiotics had a higher risk of diabetes than those who used one antibiotic class (aHR 1.14; 95% CI 1.06–1.23). ConclusionThe clear dose-dependent association between antibiotics and diabetes incidence emphasized the need for antibiotic stewardship and judicious prescription of antibiotics.