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Association between antibiotics use and diabetes incidence in a nationally representative retrospective cohort among Koreans.

ABSTRACT: Numerous studies have reported that antibiotics could lead to diabetes, even after adjusting for confounding variables. This study aimed to determine the causal relationship between antibiotics use and diabetes in a nationally representative cohort. This retrospective cohort study included adults aged 40 years or older who were enrolled in the Korean National Health Insurance Service-Health Screening Cohort. 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. The 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). The clear dose-dependent association between antibiotics and diabetes incidence supports the judicious use of antibiotics in the future.

SUBMITTER: Park SJ

PROVIDER: S-EPMC8568925 | biostudies-literature | 2021 Nov

REPOSITORIES: biostudies-literature

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Association between antibiotics use and diabetes incidence in a nationally representative retrospective cohort among Koreans.

Park Sun Jae SJ Park Young Jun YJ Chang Jooyoung J Choi Seulggie S Lee Gyeongsil G Son Joung Sik JS Kim Kyae Hyung KH Oh Yun Hwan YH Park Sang Min SM

Scientific reports 20211104 1

Numerous studies have reported that antibiotics could lead to diabetes, even after adjusting for confounding variables. This study aimed to determine the causal relationship between antibiotics use and diabetes in a nationally representative cohort. This retrospective cohort study included adults aged 40 years or older who were enrolled in the Korean National Health Insurance Service-Health Screening Cohort. Antibiotic exposure was assessed from 2002 to 2005 and newly diagnosed diabetes mellitus ...[more]

PMID: 34737360

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Project description:BackgroundMinority racial and ethnic populations have the highest prevalence of type 2 diabetes mellitus but lower use of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1ra), novel medications that reduce morbidity and mortality. Observed disparities may be due to differences in insurance coverage, which have variable cost-sharing, prior authorization, and formulary restrictions that influence medication access.ObjectiveTo assess whether racial/ethnic differences in SGLT2i and GLP1ra use differ by payer.DesignCross-sectional analysis of 2018 and 2019 Medical Expenditure Panel Survey data.ParticipantsAdults ≥ 18 years old with diabetes.Main measuresWe defined insurance as private, Medicare, or Medicaid using ≥ 7 months of coverage in the calendar year. We defined race/ethnicity as White (non-Hispanic) vs non-White (including Hispanic). The primary outcome was use of ≥ 1 SGLT2i or GLP1ra medication. We used multivariable logistic regression to assess the interaction between payer and race/ethnicity adjusted for cardiovascular, socioeconomic, and healthcare access factors.Key resultsWe included 4997 adults, representing 24.8 million US adults annually with diabetes (mean age 63.6 years, 48.8% female, 38.8% non-White; 33.5% private insurance, 56.8% Medicare, 9.8% Medicaid). In our fully adjusted model, White individuals with private insurance had significantly more medication use versus non-White individuals (16.1% vs 8.3%, p < 0.001), which was similar for Medicare beneficiaries but more attenuated (14.7% vs 11.0%, p = 0.04). Medication rates were similar among Medicaid beneficiaries (10.0% vs 9.0%, p = 0.74).ConclusionsRacial/ethnic disparities in novel diabetes medications were the largest among those with private insurance. There was no disparity among Medicaid enrollees, but overall prescription rates were the lowest. Given that disparities vary considerably by payer, differences in insurance coverage may account for the observed disparities in SGLT2i and GLP1ra use. Future studies are needed to assess racial/ethnic differences in novel diabetes use by insurance formulary restrictions and out-of-pocket cost-sharing.

Project description:BackgroundPublic health concerns have gradually shifted from inadequate intakes to potential adverse effects associated with excessive folate intakes following the full implementation of mandatory folate fortification. This study aimed to examine the associations of red blood cell (RBC) folate with all-cause and cardiovascular disease (CVD) mortality among patients with diabetes.MethodsData of 15,514 adults aged 20 years or older, who participated in the National Health and Nutrition Examination Survey (1988-1994), were analyzed as the baseline examination. The participants were linked to mortality data from the survey date until December 31, 2015. The associations of RBC folate with all-cause and CVD mortality were examined using multivariable Cox regression models.ResultsDuring 297,708 person-years of follow-up (median of 19.2 years), 6,106 total deaths occurred, including 1,867 deaths from CVD, 1452 deaths from ischemic heart disease, and 415 deaths from stroke disease. The participants with the highest quartile of RBC folate had higher odds of diabetes (fully-adjusted odds ratio: 1.94 [95% CI: 1.53-2.48]). In Cox regression analyses, compared with the participants with the lowest quartile of RBC folate for diabetes, those from quartile 3 and quartile 4 had HRs (95% CIs) of 1.12 (0.87, 1.43) and 1.30 (1.04, 1.63) in all-cause mortality, respectively; in CVD mortality, the HRs were 1.73 (1.08, 2.76) and 1.47 (0.98, 2.22); in ischemic heart disease mortality, they were 2.01 (1.19, 3.39) and 1.62 (1.05, 2.50), respectively. However, high levels of RBC folate were negatively associated with all-cause mortality, CVD mortality and ischemic heart disease mortality in non-diabetes.ConclusionFrom the nationally representative data, increasing levels in RBC folate were independently associated with an increased risk of all-cause and CVD mortality among those diagnosed with diabetes, but high levels of RBC folate had a mild protective effect in non-diabetes. The underlying mechanism regarding folate and adverse outcomes in diabetes warrants further clarification.

Dataset Information

Association between antibiotics use and diabetes incidence in a nationally representative retrospective cohort among Koreans.

Publications

Association between antibiotics use and diabetes incidence in a nationally representative retrospective cohort among Koreans.

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