Aims/hypothesis

Some studies find an increased risk of type 1 diabetes in children exposed to antibiotics. We investigated if exposure to antibiotics increases the risk of latent autoimmune diabetes in adults (LADA) and type 2 diabetes.

Methods

We used data from a Swedish case–control study (Epidemiological Study of Risk Factors for LADA and Type 2 Diabetes [ESTRID]: LADA, n=597; type 2 diabetes, n=2065; control participants matched on participation time, n=2386) and a case–control study nested within the Norwegian Trøndelag Health Study (HUNT) (n=82/1279/2050). Anatomical Therapeutic Chemical (ATC) codes indicating antibiotic dispensations were retrieved from the Swedish National Prescribed Drug Register and Norwegian Prescription Database. Multivariable adjusted ORs with 95% CIs were estimated by conditional logistic regression and pooled using fixed-effects inverse-variance weighting.

Results

We observed no increased risk of LADA with exposure to antibiotics up to 1 year (OR_pooled 1.15, 95% CI 0.93, 1.41) or 1–5 years (OR_pooled 0.98, 95% CI 0.80, 1.20) prior to diagnosis/matching for one or more vs no dispensation of any type of antibiotic. An increased risk was observed for one or more vs no dispensations of narrow-spectrum antibiotics, but not broad-spectrum antibiotics, 6–10 years prior to LADA diagnosis (OR_pooled 1.39, 95% CI 1.01, 1.91), which was driven by the Swedish data. There was little evidence of an increased risk of type 2 diabetes associated with antibiotic exposure 1–10 years prior to diagnosis.

Conclusions/interpretation

We found no evidence that exposure to broad-spectrum antibiotics up to 10 years prior to diagnosis increases the risk of LADA. There was some indication of increased LADA risk with exposure to narrow-spectrum antibiotics, which warrants further investigation.

Graphical Abstract

中文翻译：

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成人和 2 型糖尿病的抗生素暴露和潜伏性自身免疫性糖尿病的风险：瑞典病例对照研究 （ESTRID） 和挪威 HUNT 研究的结果

 目标/假设

一些研究发现，接触抗生素的儿童患 1 型糖尿病的风险增加。我们调查了抗生素暴露是否会增加成人潜伏性自身免疫性糖尿病 （LADA） 和 2 型糖尿病的风险。

 方法

我们使用了来自瑞典病例对照研究（LADA 和 2 型糖尿病危险因素流行病学研究 [ESTRID]：LADA，n=597;2 型糖尿病，n=2065;对照参与者参与时间匹配，n=2386）的数据和嵌套在挪威 Trøndelag 健康研究 （HUNT） 中的病例对照研究 （n =82/1279/2050）。从瑞典国家处方药登记册和挪威处方数据库中检索表明抗生素分配的解剖治疗化学 （ATC） 代码。通过条件 logistic 回归估计具有 95% CI 的多变量调整 OR，并使用固定效应逆方差加权合并。

 结果

我们观察到，在诊断/匹配一种或多种抗生素之前长达 1 年 （OR_合并 1.15， 95% CI 0.93， 1.41） 或 1-5 年 （OR_合并 0.98， 95% CI 0.80， 1.20） 暴露于抗生素时，LADA 风险没有增加。在 LADA 诊断前 6-10 年观察到一种或多种窄谱抗生素与未分配广谱抗生素的风险增加（OR_合并 1.39,95% CI 1.01,1.91），这是由瑞典数据驱动的。几乎没有证据表明诊断前 1-10 年抗生素暴露会增加 2 型糖尿病的风险。

结论/解释

我们没有发现证据表明在诊断前10年内接触广谱抗生素会增加LADA的风险。有一些迹象表明，暴露于窄谱抗生素会增加 LADA 风险，这需要进一步调查。

 图形摘要