The Effect of Past Antibiotic Exposure on Diabetes Risk

Eur J Endocrinol. 2015 Jun;172(6):639-48. doi: 10.1530/EJE-14-1163. Epub 2015 Mar 24.


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.

Research design and 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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / adverse effects*
  • Case-Control Studies
  • Cephalosporins / adverse effects*
  • Diabetes Mellitus, Type 1 / chemically induced*
  • Diabetes Mellitus, Type 1 / epidemiology
  • Electronic Health Records / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Humans
  • Macrolides / adverse effects*
  • Male
  • Middle Aged
  • Penicillins / adverse effects*
  • Quinolones / adverse effects*
  • Risk
  • United Kingdom / epidemiology


  • Anti-Bacterial Agents
  • Cephalosporins
  • Macrolides
  • Penicillins
  • Quinolones