Cholecystectomy is an independent factor of enhanced insulin release and impaired insulin sensitivity

Abstract

Aims

Cholecystectomy is a risk factor for insulin resistance and diabetes, but the association between cholecystectomy and insulin release/sensitivity remains obscure. We investigated the association between cholecystectomy and the factors related to glycemia and glucose tolerance.

Methods

A cross-sectional study was conducted in 2011 with 10,027 participants aged $\ge$40 in Nanjing, China. After applying exclusion criteria, 8,030 participants were divided into three groups: 1, without gallbladder disease (n = 6783); 2, with gallbladder disease but without cholecystectomy (n = 857); and 3, with cholecystectomy (n = 390).

Results

Various indexes of blood glucose and insulin level after the oral glucose tolerance test (OGTT) were assessed. The association between gallbladder disease or cholecystectomy and diabetes was evaluated with logistic regression models. Group 3 had a higher prevalence of newly diagnosed diabetes by OGTT criteria compared with groups 2 and 1, respectively (20.5% vs. 12.4% vs. 10.6%, P < 0.001). The adjusted odds ratio and 95% confidence interval of diabetes associated with cholecystectomy were 1.546 (1.168, 2.046) (P = 0.002). Pattern 2, which was characterized by a lasting late insulin response, was more frequent in group 3 compared with groups 2 and 1, respectively (61.0% vs. 54.3% vs.48.3%, P < 0.001). After adjusting for confounding factors, a higher total insulin release and lower Matsuda insulin sensitivity index (P < 0.001) were found in group 3 compared with the other two groups.

Conclusions

Cholecystectomized subjects demonstrated a higher prevalence of diabetes characterized by lower peripheral insulin sensitivity and higher total insulin release.

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.