Relationship Between Serum Bilirubin In Patients With Type2Diabetes And Diabetes-related Chronic Complications

Objectives: The purpose of this study is to investigate therelationship between serum bilirubin, serum bile acid and diabetes-relatedchronic complications such as cervical carotid atherosclerosis (CAS),diabetic retinopathy (DR) and diabetic kidney disease (DKD).Methods: Two hundred and forty-six patients with T2DM (48%male,25-87years old with average62.05years old) hospitalized for poorglycemic control were collected during January,2012to August,2012.Cervical carotid arteries were checked for existence of atherosclerosiswith ultrasound, diabetic retinopathy was examined by a ophthalmologist,diabetic nephropathy was diagnosed with urine albumin/creatinine ratio(UAlb/Cr) over30mg/g after exclusion of nondiabetic reasons.179patients were found to have cervical carotid atheroma or intima mediathickness of over0.9mm (CAS+,50.8%males).86patients were found tohave diabetic retinopathy (DR+, male38.4%).93cases (male41.9%)were found to have diabetic nephropathy (DN+). Anthropological andBiochemical data along with blood pressure were collected and analyzedby SPSS soft ware (ver17.0, Chicago, USA).Results:1. In patients with T2DM, serum levels of total bilirubin (TBil), directbilirubin (DBil) and indirect bilirubin (IBil) were negatively correlatedwith sex, diabetes duration (DD),(UAlb/Cr) and triglyceride (Trig) andwere positively correlated with diastolic blood pressure (DBP), albumin(Alb) and low density lipoprotein cholesterol (LDL-C); Direct bilirubin(DBil) was positively correlated with age, and was negatively correlatedwith fasting plasma glucose (FPD), cholesterol (Chol). Serum bile acid (TBA) was positively correlated with alanine aminotransferase (ALT) andaspartate aminotransferase (AST).2. In the CAS+group, ALT, TBil, DBil, IBil were lower than theCAS-group. Stepwise logistic analysis found that DBil was protective forCAS.3. TBil and IBil in male DR patients were lower than in male NDRgroup. TBil, DBil, IBil, TBA in female DR patients were lower than infemale NDR. Stepwise logistic analysis found that TBil and TBA wereprotective factors of DR only in females.4. TBil, DBil, IBil in the DKD+group were lower than the DKD-group. Stepwise logistic analysis found that DBil were protective for theDKD.Conclusions: Patients with T2DM complicated with CAS, and/or DRand/or DKD have lower level of serum bilirubin. Bilirubin metabolismmight be related to the pathogenesis of diabetes-related chroniccomplication.