Cholecystectomy is associated with dysglycaemia: Cross‐sectional and prospective analyses

Abstract

Cholecystectomy has been reported to be associated with increased risk of diabetes in cross-sectional studies. In the current study, we performed both cross-sectional and prospective analyses to examine the association between cholecystectomy and dysglycaemia in Chinese community-dwelling adults. A total of 1612 participants (n = 1564 without cholecystectomy and n = 48 with cholecystectomy) were evaluated for glycaemic status (according to the World Health Organization (WHO) 1999 criteria) and then followed up over ~3.2 years. Percent changes (Δ) in fasting blood glucose and HbA1c from baseline at the follow-up visit were calculated to define glycaemic control as stable (−10% ≤ Δ < 10%), improved (Δ < −10%), or worsened (Δ ≥ 10%). The baseline cross-sectional analyses indicated that cholecystectomy was associated with an increased risk of both prediabetes and diabetes, while the prospective analysis indicated that cholecystectomy was also associated with a greater risk of deterioration in glycaemic control (ΔFPG ≥10% and ΔHbA1c ≥10%) (P < 0.05 for each, both before and after adjusting for potential confounding covariates). These observations suggest that individuals in the Chinese community-dwelling population who have undergone cholecystectomy are at increased risk of dysglycaemia. Further studies are warranted to both delineate the underlying mechanisms and to clarify whether more intense surveillance for future development of diabetes is needed in this group.

Autoimmune liver diseases and diabetes: A propensity score matched analysis and a proportional meta‐analysis

“…Besides facilitating digestion and absorption of nutrients in the intestinal tract, bile acids have recently been recognised as signalling molecules, among others, involved in glucose homeostasis 34,35 . Indeed, cholecystectomy has been associated with increased risk of dysglycaemia, 36 and intrahepatic cholestasis of pregnancy has been associated with impaired glucose tolerance 37 and gestational diabetes 38 . The signalling pathways are diverse and include (i) bile acid‐induced stimulation of intestinal glucagon‐like‐peptide 1 (GLP‐1) secretion through activation of Takeda G protein‐coupled receptor 5 (TGR5) in the enteroendocrine L‐cells 39,40 thus enhancing glucose‐dependent stimulation of insulin and suppression of glucagon 41 and (ii) induction of fibroblast growth factor 19 (FGF‐19) transcription through activation of the nuclear farnesoid X receptor (FXR) in the enterocyte 34 thus inhibiting hepatic gluconeogenesis, 42 stimulating hepatic glycogen synthesis 43 and increasing peripheral glucose disposal in an insulin‐independent manner 44 …”

“…with increased risk of dysglycaemia, 36 and intrahepatic cholestasis of pregnancy has been associated with impaired glucose tolerance 37 and gestational diabetes. 38 The signalling pathways are diverse and include (i) bile acid-induced stimulation of intestinal glucagon-like-peptide 1 (GLP-1) secretion through activation of Takeda G protein-coupled receptor 5 (TGR5) in the enteroendocrine L-cells 39,40 43 and increasing peripheral glucose disposal in an insulin-independent manner.…”

The Impact of Cholecystectomy in Patients with Post-Bariatric Surgery Hypoglycemia

“…This study provides support for hypothesis that hormonal alterations caused by cholecystectomy have an impact on the diagnosis and pharmacological treatment of patients with PBH. It is known that BA, through the activation of FXR and TGR5, stimulate the production of GLP-1, an insulinotropic hormone, and hence induce changes in glucose metabolism [ 12 , 18 , 21 ]. Alterations in the kinetics of the BA enterohepatic cycle play a role in the development of PBH [ 22 ].…”

The relationship between bile acids levels and the prognosis of patients with diabetes on maintenance hemodialysis: a retrospective study

“…Recent studies have suggested that BAs play an important role in regulating postprandial glucose metabolism [ 16 ]. Another study discovered that the risk of abnormal blood glucose in individuals undergoing cholecystectomy in Chinese community residents was increased, indicating that BAs is important in maintaining blood glucose [ 17 ]. More studies have also revealed that the role of BAs in blood glucose regulation may be to activate BAs receptors involved in downstream physiological functions [ 18 ].…”