The Prevalence of Asymptomatic Gallstones in Relation to Fasting Gallbladder volume in Type 2 Diabetic Patients


  • Imad H. Tahir Thi – Qar Health Directorate / Al - Nasiryia Diabetic and Endocrine Center


Background: The sustained effect of poor glycemic control in diabetics results in a wide array of end-organ damage as a result of small and large vessels pathology. Mortality and morbidity are related to the progress of this damage but often there are acute metabolic deteriorations “1”. Autonomic neuropathy (sympathetic or parasympathetic) typically accompanies other chronic complications of DM and may play a pathogenic role through disturbed regulation of local blood flow and affecting many systems in the body including the gastrointestinal leading to(hyper-motility or hypo-motility of different organs leading to diarrhea, constipation, gastroparesis  and gall bladder hypo-motility). The gallbladder tone is maintained by the vagal activity, but the sympathetic activity has little or no effect on the gallbladder “5”. Due to autonomic neuropathy, the contraction of gallbladder is poor resulting in hypo-motility, impaired gall-bladder emptying and biliary stasis “13,14” resulting in increased gallbladder volume, which predispose to gallstones formation“15”.

Aim of study: to evaluate the prevalence of asymptomatic gallstones  in relation to of FGBV in type 2 diabetics.

Subjects and methods: 47 patient with type 2 DM were included in this study ( 37 patients were women and 10 patients were men). At first, we studied  the presence of gallstones and then we divided the subjects into two groups, those who have gallstones and those who haven’t gallstones. Thereafter, we evaluated the fasting gall bladder volume (FGBV) in each group to study the relation between the presence of gallstones and the volume of the gallbladder  in the fasting state. other parameters were studied in both groups including ( gender, age, BMI, duration of DM, serum cholesterol and TG, cigarettes smoking, family history of gallstones and HbA1c).

Result and discussion: In this study that studied two diabetic groups, one of group with gallstones and the other have no gallstones, we found that in the diabetic group without gallstones,69.7% of the patients were women, while all the diabetics with gallstones (100%) were women with a significant  difference (P-value= 0.020). The study also shows that diabetics group with gallstones have higher FGBV levels than diabetics without gallstones as most of the diabetics with gallstones (35.7%)  have FGBV in the reference range of( 21 - 30 mL³), 35.7% have FGBV in the reference range of (31 - 40 mL³), while most of the diabetics without gall-stones have FGBV levels less than20 mL³  with significant difference between the two groups (P-value=0.0004).

Conclusion: The prevalence of asymptomatic gallstones  is higher in diabetic patients  with higher levels of  FGBV than in diabetics with lower FGBV levels especially in women.


-Richard T Keays: Diabetic emergencies: Chapter 50; Intensive care manual-2009.

-American Diabetes Association (2012). Diagnosis and classification of diabetes mellitus. Diabetes care, 35 (suppl 1) : S64 - S71.

-Umesh Masharani, MB, BS, MRCP (UK): Diabetes mellitus and hypo-glycemia: Chapter 27; Current medical diagnosis and treatment-2010.

-Gordon N. Gill and David R. Clemmons: Priciples of endocrinology: chapter 240; Cecil textbook of medicine-2008.

-R.W. Chapman, J.D. Coller, and P.C. Hayes: Liver and biliary tract disease: Chapter 23; p.990; Davidson’s principles and practice of medicine-20th edition.

-Shyam Varadarajuln, Rudolf Garcia-Gallont, and Michael B.Fallon: Disorders of the gall bladder and biliary tract: Chapter 46; p.488; Cecil essentials of medicine-8th edition.

-Type 2 DM-Medscape-2013.

- Portincasa P, Moschetta A, Polasciano G. Cholesterol gallstone disease Lancet. Jul 15 2006; 363 (9531): 230 – 9.

-Ira M. Jacobson, MD: Gallstones: Chapter 50; Current diagnosis and treatment in gastroenterology-2nd edition.

- Suzanne C. Smeltzer , Brenda G. Bare, Janice L. Hinkle, Kerry H. Cheever : Assessment and management of patients with biliary disorders: Chapter 40; P.1349; Brunner & Suddarth’s textbook of medical-surgical nursing-11th edition.

- Pazzi P, Scagliarini R, Gamberini S, Pezzoli A. Review article: gall- bladder motor function in diabetes mellitus.Aliment pharmacoal Ther. 2000; 14Suppl 2:62-65.

- Liu CM, Tung TH, Liu JH, Lee WL, Chou P. A community-based epi- demiologic study on gallstone disease among type 2diabetics in Kinmen, Taiwan. Dig Dis 2004; 22:87-91.

- Kayacetin E, Kisakol G, Kaya A, Akpinar Z. real-time sonography for screening of gallbladder motility in diabetic patients:relation to autonomic and peripheral neuropathy. Neuro Endocrinol Lett. 2003; 24(1- 2): 73-76.

- Keil R. The gallbladder, biliary tract, and diabetes mellitus. Vntrlek. 2004 ; 50(5): 383-385.

- Olokoba AB, Bojuwoye BJ, Olokoba LB, Wahab KW, Salami AK, Braimoh KT, et al. The relationship between gallstone disease and gall-bladder volume. Niger J Clin Pract. 2008; 11(2): 89-93.

- Acharya SK. Diabetes mellitus and gastrointestinal system. In: Tripathy BB, Chandali HB, Das AK, Rao PV, Madhu SV, Mohan V (Eds). Rssdi: Textbook of Diabetes mellitus, Vol. 2,Jaypee Brothers Medical Publishers, 2012: pp: 939-949.

- Soad M. A. Kishk, Reda M. A. Darweesh, Wylie J. Dodds, Thomas L. Lawson, Edward T. Stewart, Mark K. Kern, Effat H. Hassanein. Sonographic Evaluation of Resting Gallbladder Volume and Postprandial Emptying in Patients with gallstones. AJR: 148, May 1987.

- Ruhl CE, Everhart JE. Association of diabetes, serum insulin, and C-peptide with gallbladder disease. Hepatology 2000; 31: 299-303.

- Novacek G. Gender and gallstone disease. Wien Med Wochenschr. 2006 oct ;156(19-20):527-33. Review . PMID: 17103289.

- Bortoff GA, Chen MYM, Ott DJ, Wolfman NT, Routh WD. Gallblsdder stones: imaging and intervention. Radiographs 2000; 20:751-766.

- Elmehdawi RR, Elmajberi SJ, Behieh A, Elramli A. Prevalence of gall bladder stones among type 2 diabetic patients in Benghazi Libya: A case-control study. Libyan J Med.2009;4(1):27-30.

- Mendez-Sanchez N, Chavez-Tapia NC, Uribe M. Gallbladder disease and obesity. Gac Med Mex. 2004 Jul-Aug; 140 Suppl 2:S59-66.

- Al-Bayati S, Kodayer S. Gallstones in a group of Iraqi patients with type2 diabetes mellitus. Saudi Med J 2012; 33(4): 412-417.

- Kratzer W, Kachele V, Mason RA, Hill V, Hay B, Haug C, Adler G, Beckh K, Muche R. Gallstone prevalence in Germany: the Ulm Gallbladder Stone Study. Dig Dis Sci 1998;43:1285-91.

- Chapman BA, Frampton CM, Wilson IR, Chisholm RJ, Allan RB, Burt MJ. Gallstone prevalence in Christchurch: risk factors and clinical significance. N Z Med J 2000; 113: 46-8.

- Attili AF, De Santis A, Attili F, Roda E, Festi D, Carulli N. Prevalence of gallstone disease in first-degree relatives of patients with cholelithiasis. World J Gastroenterol 2005;11:6508-11.

- Janowitz P, Wechsler JG, Kuhn K, Kratzer W, Tudyka J, Swobodnik W, Ditschuneit H:The relationship between serum lipids, nucleation time, and biliary lipids in patients with gallstones. Clin investing.1992, 70: 430-436.PubMedView ArticleGoogle Scholar.

- AK Agarwal, S Miglani, S Singla, U Garg, RK Dudeja, A Goel. Ultrasonic Evaluation of Gallbladder Volumein Diabetics. JAPI. VOL 52. December 2004.