Bile acids (BAs) are cholesterol-derived metabolites that facilitate the intestinal absorption and transport of dietary lipids. Recently, BAs also emerged as pivotal signaling molecules controlling glucose, lipid, and energy metabolism by binding to the nuclear hormone farnesoid X receptor (FXR) and Takeda G protein receptor 5 (TGR5) in multiple organs, leading to regulation of intestinal incretin secretion, hepatic gluconeogenesis, glycogen synthesis, energy expenditure, inflammation, and gut microbiome configuration. Alterations in BA metabolism and signaling are associated with obesity and type 2 diabetes mellitus (T2DM), whereas treatment of T2DM patients with BA sequestrants, or bariatric surgery in morbidly obese patients, results in a significant improvement in glycemic response that is associated with changes in the BA profile and signaling. Herein, we review the roles of BAs in glucose metabolism in health and disease; highlight the limitations, unknowns, and challenges in understanding the impact of BAs on the glycemic response; and discuss how this knowledge may be harnessed to develop innovative therapeutic approaches for the treatment of hyperglycemia and diabetes.

胆汁酸（BAs）是胆固醇衍生的代谢产物，可促进肠道内膳食脂质的吸收和运输。最近，BAs还通过与多个器官的核激素法呢类X受体（FXR）和Takeda G蛋白受体5（TGR5）结合，成为控制葡萄糖，脂质和能量代谢的关键信号分子，从而导致肠道肠降血糖素分泌的调节，肝糖异生，糖原合成，能量消耗，炎症和肠道微生物组构型。BA代谢和信号传导的改变与肥胖症和2型糖尿病（T2DM）有关，而对T2DM患者使用BA螯合剂治疗，或对病态肥胖的患者进行减肥手术，导致血糖反应的显着改善，这与BA分布和信号转导的变化有关。本文中，我们回顾了BAs在健康和疾病中葡萄糖代谢中的作用。突出了解BA对血糖反应的影响的局限性，未知数和挑战；并讨论如何利用这些知识开发高血糖和糖尿病的创新治疗方法。