Association between Antibiotic Exposure and Type 2 Diabetes Mellitus in Middle-Aged and Older Adults

Abstract

Background: Although previous studies have shown an association between clinically used antibiotics and type 2 diabetes, the relationship between antibiotic exposure from food and drinking water and type 2 diabetes in middle-aged and older adults is unclear. ObjectivE: This study was aimed at exploring the relationship between antibiotic exposures from different sources and type 2 diabetes in middle-aged and older people, through urinary antibiotic biomonitoring. MethodS: A total of 525 adults who were 45–75 years of age were recruited from Xinjiang in 2019. The total urinary concentrations of 18 antibiotics in five classes (tetracyclines, fluoroquinolones, macrolides, sulfonamides and chloramphenicol) commonly used in daily life were measured via isotope dilution ultraperformance liquid chromatography coupled with high-resolution quadrupole time-of-flight mass spectrometry. The antibiotics included four human antibiotics, four veterinary antibiotics and ten preferred veterinary antibiotics. The hazard quotient (HQ) of each antibiotic and the hazard index (HI) based on the mode of antibiotic use and effect endpoint classification were also calculated. Type 2 diabetes was defined on the basis of international levels. Results: The overall detection rate of the 18 antibiotics in middle-aged and older adults was 51.0%. The concentration, daily exposure dose, HQ, and HI were relatively high in participants with type 2 diabetes. After model adjustment for covariates, participants with HI > 1 for microbial effects (OR = 3.442, 95%CI: 1.423–8.327), HI > 1 for preferred veterinary antibiotic use (OR = 3.348, 95%CI: 1.386–8.083), HQ > 1 for norfloxacin (OR = 10.511, 96%CI: 1.571–70.344) and HQ > 1 for ciprofloxacin (OR = 6.565, 95%CI: 1.676–25.715) had a higher risk of developing type 2 diabetes mellitus. Conclusions: Certain antibiotic exposures, mainly those from sources associated with food and drinking water, generate health risks and are associated with type 2 diabetes in middle-aged and older adults. Because of this study’s cross-sectional design, additional prospective studies and experimental studies are needed to validate these findings.