Physiological serum total bilirubin concentrations were inversely associated with diabetic peripheral neuropathy in Chinese patients with type 2 diabetes: a cross-sectional study

Abstract

BackgroundAlthough bilirubin has been generally regarded as a waste with potential neurotoxicity at high levels, a few clinical studies suggest a potential protective role of physiological serum total bilirubin (TBIL) concentrations in diabetic peripheral neuropathy (DPN). However, the pathological mechanisms underlying the relationship remain poorly understood. The objective of this study was to explore the relationship between serum TBIL and DPN, and clinical and laboratory parameters.MethodsSerum TBIL was measured in 1342 patients with type 2 diabetes mellitus (T2DM). The relationship between TBIL and DPN and other parameters was analyzed.ResultsSerum TBIL levels were significantly lower in T2DM patients with DPN, and were independently and negatively associated with vibration perception thresholds (VPT) (P < 0.01 or P < 0.05). Moreover, serum TBIL was negatively associated with neutrophil and white blood cell counts, fibrinogen, and the prevalence of hypertension, diabetic foot ulceration, peripheral arterial disease, diabetic nephropathy and diabetic retinopathy (P < 0.01 or P < 0.05). Additionally, serum TBIL was an independent decisive factor for the presence of DPN after multivariate adjustment. Compared to the highest quartile of TBIL, the lower quartiles were associated with a significantly increased risk of DPN (P < 0.01). Last but most importantly, the analysis of receiver operating characteristic curves revealed that the best cutoff value for serum TBIL to predict DPN was 10.75 μmol/L (sensitivity 54.6% and specificity 62.9%).ConclusionsThese findings suggest that lower physiological serum TBIL may be associated with the presence of DPN due to its decreased anti-inflammatory and vascular protective effects.

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“…Kim et al, reported that low levels of STB were significantly associated with arterial stiffness in Korean women with type 2 diabetes and further suggested that STB may protect against macrovascular disease in diabetic women 9 . Furthermore, lower physiological STB may be associated with the presence of diabetic nephropathy (DPN) due to its decreased antiinflammatory and vascular protective effects 37 . A meta-analysis study indicates that STB may play a protective role in the occurrence of diabetic complications because a negative association has been reported between STB concentration and the risk of diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy 38 .…”

Association between Circulating B-Type Natriuretic Peptide and Diabetic Peripheral Neuropathy: A Cross-Sectional Study of a Chinese Type 2 Diabetic Population

“…All tests used in this study were conducted according to relevant protocols and guidelines at a certified laboratory. Urinary microalbumin and creatinine were measured, and the urinary albumin-to-creatinine ratio (ACR; mg/g creatinine) was calculated, as we described previously [ 9 ]. Renal function expressed as the eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations modified by a Japanese coefficient [ 9 ].…”

Association of Circulating Omentin-1 with Osteoporosis in a Chinese Type 2 Diabetic Population

“…Corrected calcium concentration (mg/dL) = serum calcium concentration (mg/dL)+0.8×[4.0 (g/dL−serum albumin concentration (g/dL)] Urinary microalbumin and creatinine were measured, and the urinary albumin-to-creatinine ratio (ACR; mg/g creatinine) was calculated, as we described previously [ 22 ]. Renal function expressed as the estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations modified by a Japanese coefficient [ 22 ]. Patients were then classified as having DN if they had an eGFR < 60 mL/min/1.73 m 2 and/or an ACR > 30 mg/g [ 22 ].…”

“…Renal function expressed as the estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations modified by a Japanese coefficient [ 22 ]. Patients were then classified as having DN if they had an eGFR < 60 mL/min/1.73 m 2 and/or an ACR > 30 mg/g [ 22 ].…”

“…Sensibility to touch was tested using a 10 g Semmes-Weinstein monofilament at four points on each foot: three on the plantar and one on the dorsal side. DPN was defined as VPT ≥ 25 V and/or inability to feel the monofilament [ 22 ].…”