Cholecystectomy is an independent factor of enhanced insulin release and impaired insulin sensitivity
Introduction
Cholecystectomy is the best and most cost-effective treatment for gallstone disease, which explains why it is one of the most common operations performed worldwide. This procedure has long been regarded as safe with no deleterious effects on health [1], [2]. However, recent studies indicate that cholecystectomy could be a risk factor for several components of metabolic syndrome, including dyslipidemia, hypertension, and insulin resistance (IR) [3], [4], [5]. A higher prevalence of type 2 diabetes mellitus (T2DM) was also found among cholecystectomized patients compared to controls [3]. In addition, cholecystectomy was more closely related to T2DM than gallstones [6]. T2DM is becoming a major public health problem; the prevalence in China in 2010 was 11.6%, corresponding to as many as 114 million people [7]. Since cholecystectomy and T2DM are both highly prevalent worldwide, the relationship between the two conditions deserves attention. A few studies focused on IR assessed by the Homeostasis Model Assessment (HOMA-IR), but very few have assessed insulin secretion and/or insulin sensitivity [6], [8]. Therefore, most existing analyses cannot fully account for changes in β-cell function and insulin action in cholecystectomized subjects.
To better assess whether cholecystectomy is a potential risk factor of T2DM, this study evaluated the association of cholecystectomy with insulin sensitivity and β-cell function.
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Study population
The present work was a part of the baseline survey from the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study, which was conducted with 259,657 adults aged 40 years from 25 communities across mainland China [9], [10], [11]. A total of 10,027 individuals 40 years old who lived in Gulou, Nanjing, China, were recruited to a population-based cross-sectional study from June to December 2011. The final analysis was performed among 8030 subjects after
Baseline characteristics and laboratory parameters
The clinical characteristics of the three cohorts based on medical history of gallbladder disease and cholecystectomy are listed in Table 1. Among the 8030 participants included in the final analysis, the respective prevalence rates of gallbladder disease and cholecystectomy were 15.5% (1247/8030) and 4.9% (390/8030). Participants in groups 2 and 3 were older, with higher BMI, SBP, HbA1c, and compared with those in group 1. Lower TC, LDL, and HDL were observed in groups 2 and 3 compared with
Discussion
This is a large population-based study focused on the pathophysiology of diabetes in relation to cholecystectomy using validated surrogate markers for insulin sensitivity and insulin release. We measured changes in insulin sensitivity and insulin secretion. The results demonstrate that subjects who underwent cholecystectomy had a higher prevalence of diabetes, which was characterized by increased total insulin release and decreased peripheral insulin sensitivity.
Numerous epidemiological studies
Acknowledgments
We would like to thank the members of the REACTION Study Group.
Steering Committee: Guang Ning (Principal Investigator), National Clinical Research Center for Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Yiming Mu, Chinese People’s Liberation Army General Hospital, Beijing, China; Jiajun Zhao, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China; Weiqing Wang, National Clinical Research Center for Metabolic
Funding
This study was supported by the grants from the National Clinical Research Center for Metabolic Diseases (2013BAI09B13) and the National Key New Drug Creation and Manufacturing Program of the Ministry of Science and Technology (2012ZX09303006-001).
Disclosure
The authors have no conflicts of interest to disclose.
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