Implications of Type 2 Diabetes Mellitus in Patients with Acute Cholangitis: A Systematic Review of Current Literature

Abstract

Introduction: Type 2 diabetes mellitus (T2DM) has been associated with higher rates and poorer prognosis of infections, mainly due to poor glycemic control, reduced response of T-cells and neutrophils, and impaired migration, phagocytosis, and chemotaxis of leukocytes. However, the impact of T2DM on acute cholangitis (AC) has not been assessed so far. Thus, we aimed to explore this association by means of a systematic review of the literature. Methods: This systematic review was carried out based on the recommendations stated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed/MEDLINE, Web of Science and SCOPUS databases to identify relevant publications depicting an association between T2DM and AC from the inception of these search services up to present. Results: We detected a total of 435 eligible records. After we applied the inclusion and exclusion criteria, a total of 14 articles were included in the present systematic review. Included manuscripts focused on the potential role of T2DM as a risk factor for the development of AC and on its contribution to a worse prognosis in AC, e.g., development of sepsis or other complications, the risk of AC recurrence and the impact on mortality. Conclusions: As compared to non-diabetic individuals, patients with T2DM have a higher risk of AC as a complication of choledocholithiasis or gallstone pancreatitis. Several oral hypoglycemic drugs used in the management of T2DM may also be involved in the onset of AC. Diabetic patients who suffer from AC have a higher likelihood of longer hospital stays and sepsis, as well as a higher risk of mortality and more severe forms of AC as compared to non-diabetic individuals.

Pattern of bile cultures and antibiotic sensitivity tests in Sudanese patients diagnosed with obstructive jaundice: A single‐center prospective study

“…The mean age for bacteriobilia associated with obstructive jaundice was between 61 and 75 years, representing (46%) of cases. This is in agreement with the results of other studies in the literature of reported cases of bacteriobilia in elderly patients above 70 years 11,29 . This is related to the altered immune response in the elderly patients.…”

“…Also, type-2 DM is associated with reduced response of T cells and neutrophils, impaired phagocytosis, intracellular killing, and leukocyte chemotaxis. 11 Our study showed that the positive results of bile culture is significantly associated with a confirmed history of ascending cholangitis in 34% of patients. These observations were in agreement with the study of Sharma et al who reported bacteriobilia was found more often in patients with a pervious history of cholangitis (47%) than those without (19%).…”

“…This is relevant to patients with type‐2 DM who have poor glycemic control and diabetic neuropathy. Also, type‐2 DM is associated with reduced response of T cells and neutrophils, impaired phagocytosis, intracellular killing, and leukocyte chemotaxis 11 . Our study showed that the positive results of bile culture is significantly associated with a confirmed history of ascending cholangitis in 34% of patients.…”

“…Hence, new criteria were established by the Tokyo guidelines, which have an overall sensitivity and specificity of 92 and 78%, respectively. These new criteria included laboratory and clinical signs of systemic inflammation, in addition to cholestasis and imaging evidence of biliary obstruction 11 . Persistence of biliary obstruction leads to inaccurate antibiotic concentration and excretion, particularly if associated with high bilirubin, low albumin, and tachycardia.…”

Global Needs and Barriers for Medical Research Education: Initiatives to Solve the Physician-Scientists Shortage

“…We see the successfully published articles of these collaborations as a transcript of our efforts. The manuscripts tackled topics in the fields of hematology and oncology, [17][18][19][20][21][22][23] ethics (e.g., diversity, equity and inclusion), [24][25][26][27] infectious diseases, 28,29 surgery, 30,31 pediatrics, 32 and physical and rehabilitation medicine. [33][34][35] We invite you to read them and encourage you to include students and early career scientists in your research projects.…”