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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 3  |  Page : 128-131

Occurence of gallbladder stones and its association with HbA1C among participants with type 2 diabetes mellitus: One-year cross-sectional study


Department of General Medicine, J. N. Medical College, Belagavi, Karnataka, India

Date of Submission05-Aug-2019
Date of Acceptance01-Mar-2020
Date of Web Publication15-Jul-2020

Correspondence Address:
Dr. Vivek Veereshkumar Shirol
B - 7/1, Staff Quarters, JNMC Campus, Nehru Nagar, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AJIM.AJIM_35_19

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  Abstract 


Aims: The aim was to study the occurrence of gallbladder stones and its association with HbA1c among participants with Type 2 diabetes mellitus. Settings and Design: This was a 1-year cross-sectional study. Subjects and Methods: The study was done on 200 participants of Type 2 diabetes mellitus admitted in the Department of General Medicine over a period of 1 year from January 2018 to December 2018. A thorough medical history was obtained, and clinical examination and investigations were performed on the study participants. Ultrasonography of the abdomen was done with special reference to gallbladder and gallstones. Statistical Analysis: The data were entered into Excel 2010 and analyzed by SPSS version 20.0 software. The data were analyzed by descriptive statistics including frequency, percentage, mean, and standard deviation. The Chi-square test was used to assess the association between the two attributes. Results: The occurrence of gallbladder stones was 33.50%, with 67 Type 2 diabetes mellitus participants having asymptomatic gallstones out of the total 200 study participants. The association of higher occurrence of gallstones was found to be statistically significant with higher HbA1c values. In the participants with gallstones, the mean HbA1c was 9.67 ± 2.16%. The maximum number of participants belonged to the group of study participants having HbA1c range of 08%–9.9%, which consists of 44.5% of the total study participants. Conclusions: The occurrence of gallbladder stones was 33.50% among Type 2 diabetes participants. A higher HbA1c level was found to be significantly associated with gallstone formation. This knowledge may provide an early interventional opportunity to implement adequate measures for a strict glycemic control and prevent further morbidity and mortality.

Keywords: Gallstones, HbA1c, Type 2 diabetes mellitus, ultrasonography


How to cite this article:
Shirol VV, Motimath PS. Occurence of gallbladder stones and its association with HbA1C among participants with type 2 diabetes mellitus: One-year cross-sectional study. APIK J Int Med 2020;8:128-31

How to cite this URL:
Shirol VV, Motimath PS. Occurence of gallbladder stones and its association with HbA1C among participants with type 2 diabetes mellitus: One-year cross-sectional study. APIK J Int Med [serial online] 2020 [cited 2020 Oct 31];8:128-31. Available from: https://www.ajim.in/text.asp?2020/8/3/128/289792




  Introduction Top


Diabetes mellitus refers to a group of metabolic disorders that share the phenotype of hyperglycemia. The worldwide occurrence of diabetes mellitus has risen dramatically over the past two decades. Diabetes-related complications affect many organ systems and are responsible for the majority of morbidity and mortality associated with the disease.[1] An altered glucose metabolism may increase the risk of cholelithiasis in certain individuals.[2]

Diabetics could form cholesterol gallstones more frequently because of a reduced gallbladder contraction and increased biliary cholesterol secretion.[3] A meta-analysis study suggested that there is a strong association between diabetes mellitus and the occurrence of gallstone disease.[4] The incidence of gallstones is higher in Type 2 diabetics both in males and females than the nondiabetics.[5]

The mean gallbladder volume is significantly increased in Type 2 diabetic participants as compared to nondiabetic healthy controls.[6] Poor control of diabetes and hypercholesterolemia are important risk factors for the development of gallbladder disease.[7]

Recent studies suggest that the association between gallstone formation and diabetes can be explained by chronic hyperglycemia, decrease in gallbladder motility, and associated obesity as risk factors in participants with Type 2 diabetes mellitus.[8],[9] Many of the diabetes-related complications can be prevented or delayed with early detection and aggressive glycemic control.[1]

The objective of the present study was to have more knowledge about the occurrence of gallbladder stones and its association with HbA1c levels among participants with Type 2 diabetes mellitus.


  Subjects and Methods Top


The study was done on 200 participants of Type 2 diabetes mellitus admitted in the Department of General Medicine over a period of 1 year from January 2018 to December 2018.

Inclusion criteria

All the participants of Type 2 diabetes mellitus with a 5-year or more than 5-year duration of diabetes mellitus admitted in the general medicine wards.

Exclusion criteria

  1. Participants of Type 2 diabetes mellitus who have undergone cholecystectomy
  2. Type 2 diabetics with acute complications
  3. Participants of Type 1 diabetes mellitus.


The criteria for the diagnosis of diabetes were as follows:

  1. Random blood glucose >200 mg/dl
  2. Fasting blood glucose >126 mg/dl
  3. Postprandial blood glucose >200 mg/dl.


After taking the written informed consent from the participants, a detailed history including age, sex, and duration of diabetes was taken. A detailed physical examination was performed, and fasting blood glucose, postprandial blood glucose, HbA1c, blood urea, serum creatinine, lipid profile, and routine urine examination results were recorded.

Ultrasonography of the abdomen was done with GE Healthcare LOGIQ P7 ultrasound machine with 3–5 MHz transducer. With special reference to gallbladder and gallstones, the ultrasonography was performed. Parameters that were recorded were as follows: gallbladder wall, gallbladder, gallstones, and biliary sludge.

Statistical analysis

The obtained data were entered into Excel 2010. It was converted and analyzed by SPSS version 20.0 software IBM (International Business Machines Corporation), American Multinational Technology Company. The data were analyzed by descriptive statistics including frequency, percentage, mean, and standard deviation. The independent t-test was used to compare the data of the participants with and without gallstone groups with various quantitative parameters. The Chi-square test was used to assess the association between the two attributes.


  Results Top


The final results of the study are presented in [Table 1].
Table 1: Occurrence of gallstones

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The occurrence of gallbladder stones in the present study is 33.50%. The study included a total of 200 participants, and 67 of them had asymptomatic gallstones.

[Table 2] shows the distribution of the study participants based on their HbA1c levels. The maximum number of participants belonged to the group of study participants having HbA1c range of 08%–9.9%, which consists of 44.5% of the total study participants.
Table 2: Hemoglobin A1c wise distribution

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[Table 3] shows the association between HbA1c and the occurrence of gallstones. It is evident from the chart [Graph 1] that the occurrence of gallstones increases with the increase in the HbA1c of the study participants. The association is statistically significant (P = 0.0229).
Table 3: Association between hemoglobin A1c and the occurrence of gallstones

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[Table 4] depicts the comparison of participants without and with gallstones status with HbA1c by independent t-test. The participants with gallstones have significantly higher HbA1c levels as compared to the participants without gallstones.
Table 4: Comparison of participants without and with gallstones status with hemoglobin A1c by independent t-test

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  Discussion Top


Diabetes mellitus is a growing health-care problem worldwide and is characterized by many complications.

The occurrence of gallbladder stones was studied in 200 Type 2 diabetes mellitus participants in the present study. It was found that the occurrence of gallbladder stones was 33.50%, with 67 Type 2 diabetes mellitus participants having asymptomatic gallstones. The observation of the present study is comparable to a study done by Chhabra et al., which also reports a 34% occurrence of gallstones in participants of Type 2 diabetes mellitus.[7] Another study done by Al-Kayatt and Al-Youzbaki[10] in 2012 also reported a occurrence of gallstones in Type 2 diabetes mellitus to be 33%. Similarly, the study done by Chapman et al. found the occurrence to be 32.7%.[11] Guimaraes et al. showed a occurrence of gallstones in Type 2 diabetics to be 37.1%.[9] Few of the Indian studies done to assess the occurrence of gallstones in Type 2 diabetics depicted similar findings. The findings of the study by Raman et al.[6] report the occurrence of the gallstones in diabetics to be 32%. Saxena et al.[12] also studied the participants of Type 2 diabetes mellitus and found that 29% of the participants had ultrasonographic evidence of gallstones. Gupta et al.[13] also reported a significant increase in the presence of gallstones in Type 2 diabetes mellitus participants. Other studies from different countries showed different figures. In Taiwan, the occurrence of gallstones in diabetic participants was 14.4%.[14] Pagliarulo et al. from Italy showed a occurrence of 24.8%,[15] and Agunloye et al. from Nigeria showed the occurrence of asymptomatic gallstone disease in participants of Type 2 diabetes mellitus to be 17.5%.[16] Such variation in the occurrence of gallbladder stones in Type 2 diabetes mellitus participants across the globe could be attributed to the different study designs, geographical variation, and the difference in ethnicity of the participants.[17]

A high level of HbA1c reflects poor control of diabetes mellitus. The distribution of participants in the present study according to the levels of HbA1c is as follows. The HbA1c group of 6.5%–7.9% had 58 participants. The group of 8%–9.9% contains 89 participants, and finally, the HbA1c group of ≥10% had 53 participants. The present study found that there was a statistically significant association between HbA1c levels and gallstones (P = 0.0229). With the increase in HbA1c levels, there was a high occurrence of gallstones among Type 2 diabetes mellitus participants. The mean HbA1c level in the present study in participants with gallstones was 9.67% ± 2.16%. The findings of the present study were consistent with the findings of the study done by Khare and Gupta.[18] with a mean HbA1c level in participants with Type 2 diabetes mellitus and gallstones being 9.72% ± 2.78%. The study done by Khalaf[19] reported a mean HbA1c level of 11.01% ± 2.1%.


  Conclusion Top


In the present study, the occurrence of gallbladder stones was 33.50% among Type 2 diabetes mellitus participants. A higher HbA1c level was found to be significantly associated with gallstone formation. This knowledge may provide an early interventional opportunity to implement adequate measures for a strict glycemic control and prevent further morbidity and mortality.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors. Harrison's Principles of Internal Medicine. 19th ed., Vol. 2. New York: McGraw-Hill Education; 2015. p. 2399-440.  Back to cited text no. 1
    
2.
De Santis A, Attili AF, Ginanni Corradini S, Scafato E, Cantagalli A, De Luca C, et al. Gallstones and diabetes: A case-control study in a free-living population sample. Hepatology 1997;25:787-90.  Back to cited text no. 2
    
3.
Attili AF, Capocaccia R, Carulli N, Festi D, Roda E, Barbara L, et al. Factors associated with gallstone disease in the MICOL experience. Multicenter Italian study on epidemiology of cholelithiasis. Hepatology 1997;26:809-18.  Back to cited text no. 3
    
4.
Wen Wang WM, Li N. The association of gallstone diseases and diabetes mellitus. A meta-analysis. Saudi Med J 2014;35:1005-12.  Back to cited text no. 4
    
5.
Anmar HA. Association between gallstones and diabetics type 2 Iraqi participants. Iraqi J Pharm Sci 2011;20:38-43.  Back to cited text no. 5
    
6.
Raman PG, Patel A, Mathew V. Gallbladder disorders and type 2 diabetes mellitus–A clinic-based study. J Assoc Physicians India 2002;50:887-90.  Back to cited text no. 6
    
7.
Chhabra A, Grover S, Vij A, Singh AP. Gallbladder disease in type 2 diabetes mellitus participants. Int J Med and Dent Sci 2013;2:7-15.  Back to cited text no. 7
    
8.
Parambil SM, Matad S, Soman KC. Epidemiological, demographic and risk factor profile in participants harbouring various types of gallbladder calculi: Across sectional study a south Indian tertiary care hospital. Int Surg J 2017;4:525-8.  Back to cited text no. 8
    
9.
Guimaraes SV, Gomes HL, Oliverira CG, Chiacchio MF, Souza FM, Oliveira DS, et al. Prevalence of cholelithiasis in participants with type 2 diabetes and obesity in a basic family health centre in Irece Northeastern Brazil. Open J Endocr Metab Dis 2016;6:38-42.  Back to cited text no. 9
    
10.
Al-Kayatt MK, Al-Youzbaki DB. Sociological risk factors in the development of gallstones for women in the childbearing age a case-control study. Irazi J Comm Med 2009;21:97-103.  Back to cited text no. 10
    
11.
Chapman BA, Wilson IR, Frampton CM, Chisholm RJ, Stewart NR, Eagar GM, et al. Prevalence of gallbladder disease in diabetes mellitus. Dig Dis Sci 1996;41:2222-8.  Back to cited text no. 11
    
12.
Saxena R, Sharma S, Dubey DC. Gallbladder disorder in type 2 diabetes mellitus cases. J Hum. Ecol 2005;18:169-71.  Back to cited text no. 12
    
13.
Gupta RS, Rao HK, Singh AR, Singh AP. Gall bladder disease in type 2 diabetes mellitus. J Assoc Physicians India 2008;50:223-5.  Back to cited text no. 13
    
14.
Liu CM, Tung TH, Liu JH, Lee WL, Chou P. A community-based epidemiologic study on gallstone disease among type 2 diabetics in Kinmen, Taiwan. Dig Dis 2004;22:87-91.  Back to cited text no. 14
    
15.
Pagliarulo M, Fornari F, Fraquelli M, Zoli M, Giangregorio F, Grigolon A, et al. Gallstone disease and related risk factors in a large cohort of diabetic participants. Dig Liver Dis 2004;36:130-4.  Back to cited text no. 15
    
16.
Agunloye AM, Adebakin AM, Adeleye JO, Ogunseyinde AO. Ultrasound prevalence of gallstone disease in diabetic participants at Ibadan Nigeria. Niger J Clin Pract 2013;16:71-5.  Back to cited text no. 16
[PUBMED]  [Full text]  
17.
Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterol Clin North Am 2010;39:157-69, vii.  Back to cited text no. 17
    
18.
Khare S, Gupta H. Prevalence and risk factors of asymptomatic gall stone in patient with type 2 diabetes mellitus. Int J Sci Res 2015;4:671-4.  Back to cited text no. 18
    
19.
Khalaf SK. Asymptomatic gallstones in diabetic participants. Bas J Surg 2015;2:63-9.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
Subjects and Methods
Results
Discussion
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