It may be a classic case of the chicken or the egg. Danish scientists have found a link between diabetes risk and the use of antibiotics.
What’s unknown, though, is which came first. Does using antibiotics increase the risk of developing Type 2 diabetes? Or do people who develop the disease need more antibiotics because they’re more prone to infections?
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Researchers identified 170,504 people with diabetes and compared them to 1,364,008 people who didn’t have diabetes to see how often both groups used antibiotics. They looked at antibiotic use from Jan. 1, 2000, until Dec. 31, 2012, using government databases. The objective of the study was to find out whether the use of antibiotics affects the risk of developing Type 2 diabetes and whether specific types of antibiotics were to blame.
People who filled two to four antibiotic prescriptions had a 23 percent higher risk of diabetes than people who hadn’t filled any.
What they found was that people who filled two to four antibiotic prescriptions had a 23 percent higher risk of diabetes than people who hadn’t filled any. People who filled five or more prescriptions had a 53 percent higher risk, the study found.
The study, published in the Journal of Clinical Endocrinology & Metabolism, also found that increased use of antibiotics in people with Type 2 diabetes was found up to 15 years before diagnosis of the disease as well as after the diagnosis.
Researchers acknowledge two competing interpretations of their findings. The first is that people with Type 2 diabetes are more prone to infections many years before they are diagnosed and need more antibiotics to treat those infections. The second is that antibiotics increase the risk of Type 2 diabetes.
“I think Type 2 diabetic individuals are more susceptible to infection,” Dr. Ramin Oskoui, an associate professor of medicine at Georgetown University School of Medicine, told LifeZette.
“Remember the authors even conclude, ‘Our results could support the possibility that antibiotics exposure increases Type 2 diabetes risk. However, the findings may also represent an increased demand for antibiotics from increased risk of infections in patients with yet-undiagnosed diabetes.’”
The study pointed out that earlier research had found that people with diabetes had more urinary tract, skin and respiratory tract infections, all of which can be treated with antibiotics.
Obesity, which often comes before diabetes, also raises the risk of infection, the study said.
Findings may reflect “demand for antibiotics from increased risk of infections in patients with yet-undiagnosed diabetes.’”
The study noted that research in mice had found that antibiotics might change gut bacteria and affect insulin sensitivity and glucose tolerance, among other things. Antibiotics have been used for decades to help livestock gain weight, the study said.
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The authors said there’s increasing evidence that bacteria in the human gut affects nutrient metabolism.
Javier M. Garcia, a 51-year-old chef in Los Angeles, has had diabetes for about seven years. Before his diagnosis, he didn’t go to the doctor.
“I was a pretty healthy person, and beside the diabetes, I don’t get sick that often,” he told LifeZette.
The news about the connection between diabetes risk and antibiotic use surprised Garcia. He doesn’t dismiss the connection, but said it doesn’t apply to him. Everyone is different, though, he said.
“At least in my case, I don’t think I need to take more antibiotics because of the diabetes,” he said.
Oskoui said it’s possible the food industry is trying to blame a biotic gut flora selected by individual antibiotic use as the culprit rather than antibiotics used in agriculture or carb-laden diets.
“You’d never find this small effect if you weren’t trolling a huge database,” Oskoui said. “It is possible that the prediabetics have an altered immune system as they make their way to diabetes. With that said, this is an important topic — how antibiotics change the gut flora and impact metabolism.”
One challenge with this kind of study, the authors noted, is defining the onset of diabetes. Estimates in Denmark show that at least 40 percent of people with Type 2 diabetes are undiagnosed, and patients may have undiagnosed diabetes for several years. A study published earlier this month in JAMA estimates that half of Americans have diabetes or prediabetes.
“To this point, there is no conclusive evidence that any antibiotic usage actually causes Type 2 diabetes but it is worth exploring further,” Dr. Lisa Benya, founder of CURE Concierge and a staff member at St. John’s Hospital and Santa Monica-UCLA Hospital, told LifeZette.
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“Much research is being done on this as we speak,” Benya said. “It could be actually that those clients that develop diabetes have a lower immune system, which causes them to catch more infections, requiring them to take more antibiotics.”
Researchers said the possibility that antibiotic use increases diabetes risk deserves further investigation and suggest more research into the long-term effects of antibiotics on the body, including metabolism. In particular, they suggested more research on commonly used penicillin.
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