Long-term use of antibiotics and risk of type 2 diabetes in women: a prospective cohort study

BACKGROUND: Accumulating evidence suggested that long-term antibiotic use may alter the gut microbiome, which has, in turn, been linked to type 2 diabetes. We undertook this study to investigate whether antibiotic use was associated with increased risk of type 2 diabetes.

METHODS: This prospective cohort study included women free of diabetes, cardiovascular disease and cancer in the Nurses' Health Study (NHS 2008-2014) and NHS II (2009-2017). We evaluated the overall duration of antibiotics use in the past 4 years and subsequent diabetes risk with Cox proportional-hazards regression adjusting for demography, family history of diabetes and lifestyle factors.

RESULTS: Pooled analyses of NHS and NHS II (2837 cases, 703 934 person-years) revealed that a longer duration of antibiotic use in the past 4 years was associated with higher risk of diabetes [Trend-coefficient = 0.09, 95% confidence interval (CI) 0.04 to 0.13]. Participants who received antibiotics treatment for a medium duration of 15 days to 2 months [hazard ratio (HR) 1.23, 95% CI 1.10 to 1.39] or long duration of >2 months (HR 1.20, 95% CI 1.02 to 1.38) had higher risk of type 2 diabetes as compared with non-users. Subgroup analyses suggested that the associations were unlikely to be modified by age, family history of diabetes, obesity, smoking, alcohol drinking, physical activity and overall diet quality.

CONCLUSIONS: A longer duration of antibiotic use in recent years was associated with increased risk of type 2 diabetes in women. Physicians should exercise caution when prescribing antibiotics, particularly for long-term use.