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Metformin and other glucose-lowering drug initiation and rates of community-based antibiotic use and hospital-treated infections in patients with type 2 diabetes: a Danish nationwide population-based cohort study
  1. Anil Mor1,
  2. Irene Petersen1,2,
  3. Henrik T Sørensen1,
  4. Reimar W Thomsen1
  1. 1Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
  2. 2Research Department of Primary Care and Population Health, University College London, London, UK
  1. Correspondence to Dr Anil Mor; anil.mor{at}


Objective Data on early risk of infection in patients receiving their first treatment for type 2 diabetes are limited. We examined rates of community-based antibiotic use and hospital-treated infection in initiators of metformin and other glucose-lowering drugs (GLDs).

Design Population-based cohort study using medical databases.

Setting General practice and hospitals in Denmark.

Participants 131 949 patients with type 2 diabetes who initiated pharmacotherapy with a GLD between 2005 and 2012.

Exposure Initial GLD used for pharmacotherapy.

Main outcome measures We computed rates and adjusted HRs of community-based antibiotic use and hospital-treated infection associated with choice of initial GLD with reference to metformin initiation, using an intention-to-treat approach.

Results The rate of community-based antibiotic use was 362 per 1000 patient-years at risk (PYAR) and that for hospital-treated infection was 51 per 1000 PYAR. Compared with metformin, the risk of hospital-treated infection was slightly higher in sulfonylurea initiators (HR 1.12, 95% CI 1.08 to 1.16) and substantially higher in insulin initiators (HR 1.63, 95% CI 1.54 to 1.72) initiators after adjustment for comorbid conditions, comedications and other confounding factors. In contrast, virtually no difference was observed for overall community-based antibiotic use (HR 1.02, 95% CI 1.01 to 1.04, for sulfonylurea initiators; and 1.04, 95% CI 1.01 to 1.07, for insulin initiators).

Conclusions Rates of community-based antibiotic treatment and hospitalisation for infection were high in patients receiving their first treatment for type 2 diabetes and differed with the choice of initial GLD used for pharmacotherapy.

  • hypoglycaemic agents
  • type 2 diabetes mellitus
  • pharmacoepidemiology
  • infections
  • antibiotics

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