Background: Antibiotics in childhood are commonly used and have been linked to gut microbiome dysbiosis and metabolic disorders. However, direct evidence regarding the association between long-term or recurrent antibiotic use (LRAU) during early life and diabetes was scarce. We performed this study to investigate this association in two population-based studies.
Methods: We undertook a prospective analysis encompassing 147 010 participants from the UK Biobank. Cox proportional hazard regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of self-reported LRAU during early life on diabetes risk. We also conducted a case-control study within the Chinese population, in which 263 diabetes cases and 526 controls were matched for age and living location. Odds ratios (ORs) and 95% CI were was calculated using logistic regression models.
Results: We identified 4314 incident cases of type 2 diabetes over 1 840 944 person-years of follow-up in the UK Biobank. LRAU during early life was associated with a 26% higher risk of diabetes after accounting for putative risk factors (HR, 1.26; 95% CI, 1.16-1.37) in the UK biobank. We observed a more evident association between LRAU and an elevated risk of diabetes in the case-control study (OR, 3.32; 95% CI, 2.06-5.38). The primary finding was robust to several subgroup analyses and sensitivity analyses.
Conclusions: LRAU during early life may increase the risk of type 2 diabetes. Caution should be exercised when prescribing long-term or recurrent antibiotics to children and adolescents.
Keywords: UK biobank; antibiotics; case–control study; cohort study; type 2 diabetes.
© 2025 The Author(s). Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.