The Relationship Between Serum Total Bile Acids And Glycolipid Metabolism Indexes In Hospitalized Patients With Type 2 Diabetes Mellitus

Background and objective:In recent years,the incidence of type 2 diabetes mellitus?T2DM?and abnormal lipid metabolism has gradually increased,which has greatly increased the prevalence and mortality risk of T2DM-related macrovascular disease.Bile acid is the final product of cholesterol,which plays an important role in promoting the absorption of intestinal fat and fat-soluble vitamins.However,more and more recent studies have found the importance of bile acid in glycolipid metabolism.Studies have found that the increase in serum bile acid after bariatric-surgery may be related to improve metabolism and weight loss,and serum bile acid levels are also increased in patients with T2DM.Serum bile acid may be related to T2DM glycolipid metabolism,but there are relatively few studies on the relationship between serum bile acid and T2DM glycolipid metabolism,and some are controversial.Therefore,by observing the relationship between total bile acids?TBA?and glycolipid metabolism index in T2DM patients,this study aims to find a new target for the prevention and intervention of glycolipid metabolism disorder in T2DM patients.Methods:A total of 641 T2DM patients were selected who were admitted to the Endocrinology Department of the First Affiliated Hospital of Dalian Medical University from January 1,2017 to December 31,2019.The clinical information about the subjects including age,gender,duration of diabetes,height?H?,weight?W?,waist circumference?WC?.All the patients were venipunctured to examine the biochemical markers,such as TBA?total cholesterol?TC??triglyceride?TG??low-density lipoprotein cholesterol?LDL-C??high-density lipoprotein cholesterol?HDL-C??glycated hemoglobin A1c?Hb A1c??fasting C-peptide?FCP??glucagon?Glc??fasting plasma glucose?FPG??fasting insulin?FIns??thyroid stimulating hormone?TSH??free thyroxine?FT₄??free triiodothyronine?FT₃?.Body mass index?BMI??homeostasis model assessment of insulin resistance?HOMA-IR??glucagon-to-insulin radio?GIR??glucagon-to-C peptide radio?GCR?were evaluated by formula.The objects were divided into T1,T2,and T3 groups according to the tertile division of serum TBA level from low to high.Compare the differences of various indexes among the three groups.Correlation analysis was performed to explore the relationship between TBA and the above indexes.Compare the incidence of dyslipidemia?hypertriglyceridemia?hypercholesterolemia?high blood LDL-C?low blood HDL-C and insulin-resistance between groups,and finally the serum TBA level was used to predict the optimal threshold for insulin-resistance in hospitalized T2DM patients.Results:1.There were significant differences in age,TG,Hb A1c,FCP,GLC,FIns,HOMA-IR and Hb A1c between the tertiles of TBA.comparing the two groups,age,the T3 group was higher than the T1 group[61?54?68?years vs 59?48?65?years,P<0.01],and the T3 group was higher than the T2 group[61?54?68?years vs.57?47?64?years old,P<0.01];TG level,the T3 group was higher than the T2 group[1.84?1.25?3.10?mmol/L vs 1.823?1.31?2.83?mmol/L,P<0.05],The T3group was higher than the T1 group[1.84?1.25?3.10?mmol/L vs 1.65?1.14?2.37?mmol/L,P=0.01];serum FCP showed an upward trend with the increase in TBA[1.38?0.82?1.86?mmol/L vs 1.73?1.16?2.33?mmol/L vs 1.85?1.34?2.57?mmol/L,P<0.001];Glc level,the T3 group is higher than the T1group[105.17?71.6?130.50?)mmol/L vs 85.89?60.28?123.58?mmol/L,P<0.01],the T2 group is higher than the T1 group[103.06?70.94?132.80?mmol/L vs 85.89?60.28?123.58?mmol/L,P<0.01];FIns level,the T3 group was higher than the T1 group[8.08?4.46?12.33?m IU/L vs 5.97?3.75?10.01?m IU/L,P<0.05];HOMA-IR,the T3 group was higher In the T1 group[2.15?1.12?3.76?vs1.73?0.98?2.68?,P<0.05];Hb A1c level,the T3 group was lower than the T2[9.3?8.1?11.0?%vs 9.1?8.1?10.5?%,P<0.05],the T3 group was lower than the T1group[9.3?8.1?11.0?%vs 8.9?7.5?10.0?%,P<0.01].There were no statistical differences between the tertiles of TBA in gender,duration of diabetes,BMI,WC,TC,HDL-C,LDL-C,GCR,FPG,GIR,TSH,FT₃,and FT₄?P>0.05?.2.The Spearman correlation analysis showed that TBA was positively correlated with age,TG,FCP,Glc,FIns,HOMA-IR and TSH?P<0.05?,and negatively correlated with Hb A1c and GCR?P<0.05?.TBA was not significantly correlated with gender,duration of diabetes,BMI,WC,TC,HDL-C,LDL-C,FPG,GIR,FT₃and FT₄?P>0.05?.3.There were significant differences in the incidence of hypertriglyceridemia between the tertiles of TBA,the incidence of hypertriglyceridemia of highest tertile?39.0%?and the middle tertile?37.1%?was significantly higher than that of the lowest tertile?26.8%??P<0.05?,while there were no differences in the incidence of hypercholesterolemia?dyslipidemia?high blood LDL-C?low blood HDL-C between the tertiles of TBA?P>0.0?.4.There were significant differences in the incidence of insulin-resistance between the tertiles of TBA,the incidence of insulin-resistance of highest tertile?44.7%?and the middle tertile?38.1%?was significantly higher than that of the lowest tertile?24.2%??P<0.01?.5.Binary multivariate logistic regression analysis showed that women,BMI,TBA,and FCP were risk factors for insulin-resistance.In terms of odds ratio OR,with other factors unchanged,the risk of insulin-resistance in men was 0.420 times that of women.For every unit increase in BMI,TBA,and FCP levels,the risk of insulin-resistance is1.121 times,1.064 times,and 2.128 times,respectively.6.Generating receiver operating characteristic curve?ROC?with insulin-resistance at serum TBA level,The best critical point for predicting insulin-resistance in hospitalized T2DM patients was TBA?3.35?mol/L.The sensitivity of this point was76.7%,the specificity was 39.9%,and the Youden index was 0.166.Conclusions:1.In hospitalized T2DM patients,serum TBA was positively correlated with age,TG,FCP,Glc,FIns,HOMA-IR and TSH,and negatively correlated with Hb A1c and GCR.2.The incidence of hypertriglyceridemia and insulin-resistance in hospitalized T2DM patients increased with the increase of serum TBA,and serum TBA is an independent risk factor for insulin-resistance.3.Serum TBA may be one of the serological markers for reflecting insulin-resistance in hospitalized T2DM patients.