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Low serum total bilirubin concentration in patients with type 1 diabetes mellitus complicated by retinopathy and nephropathy

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Abstract

Aims

Although a relationship between serum bilirubin concentration and diabetic microangiopathy in patients with type 2 diabetes has been reported, whether such a relationship exists in patients with type 1 diabetes is unknown. This study assessed the relationships between serum total bilirubin concentration and retinopathy/nephropathy in patients with type 1 diabetes.

Methods

A total of 126 patients with type 1 diabetes were investigated in this cross-sectional study. Serum total bilirubin concentration was compared between patients with and without diabetic retinopathy/nephropathy, and among the categories stratified according to the severity of retinopathy/nephropathy. A logistic regression model was used to assess the association of retinopathy/nephropathy with total bilirubin. Finally, total bilirubin concentration was compared among patients with none, either, or both diabetic retinopathy and nephropathy.

Results

Serum total bilirubin concentration was significantly lower in patients with retinopathy/nephropathy than in those without complications. Receiver operating characteristic analysis indicated that a bilirubin concentration of 0.55 mg/dl might be the appropriate threshold for the detection of retinopathy/nephropathy. Total bilirubin concentration differed significantly according to the severity of microangiopathy. In logistic regression analyses, total bilirubin level was significantly inversely associated with retinopathy/nephropathy. Moreover, bilirubin level in patients with either retinopathy or nephropathy was significantly higher than that in patients with both of them, and significantly lower than that in patients with neither of them.

Conclusions

Total bilirubin concentration was shown to be lower in patients with type 1 diabetes complicated by retinopathy/nephropathy. Bilirubin might function protectively against microangiopathy in patients with type 1 diabetes.

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Conflict of interest

R.S., M.T., and T.N. declare that they have no conflict of interest. H.I. has received compensation from NIPRO, lecture fees from Takeda and MSD, and scholarship grants from Sanofi-Aventis, Astellas, Takeda, MSD, and Daiichi Sankyo.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Keio University School of Medicine, an Ethical Committee) and with the Helsinki Declaration of 1964 and its subsequent revision. Informed consent was obtained from all patients to be included in the study.

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Author notes

  1. Risa Sekioka

    Present address: Department of Internal Medicine, Jujo Takeda Rehabilitation Hospital, 32 Kisshoinhatsutandacho, Minami-ku, Kyoto, 601-8325, Japan

Authors and Affiliations

  1. Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Risa Sekioka, Masami Tanaka, Takeshi Nishimura & Hiroshi Itoh

Authors
  1. Risa Sekioka
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  2. Masami Tanaka
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  3. Takeshi Nishimura
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  4. Hiroshi Itoh
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Corresponding author

Correspondence to Risa Sekioka.

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Sekioka, R., Tanaka, M., Nishimura, T. et al. Low serum total bilirubin concentration in patients with type 1 diabetes mellitus complicated by retinopathy and nephropathy. Diabetol Int 6, 300–305 (2015). https://doi.org/10.1007/s13340-014-0201-z

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  • DOI: https://doi.org/10.1007/s13340-014-0201-z

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