Huh, Ji Hye MD, PhD*; Lee, Kyong Joo MD, PhD*; Cho, Yun Kyung MD, PhD†,‡; Moon, Shinje MD, PhD*; Kim, Yoon Jung MD, PhD*; Roh, Eun MD, PhD*; Han, Kyung-do PhD§; Koh, Dong Hee MD, PhD*; Kang, Jun Goo MD, PhD*; Lee, Seong Jin MD, PhD*; Ihm, Sung-Hee MD, PhD*

*Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
†Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
‡Asan Diabetes Center, Asan Medical Center, Seoul, Republic of Korea
§Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea

Ji Hye Huh and Kyong Joo Lee contributed equally to this study as first authors.
Corresponding author: Kang, Jun Goo MD, PhD

Objective: This study assessed whether cholecystectomy is a risk factor for newly developed T2DM in Korean population.

Background: There is a lack of evidence that cholecystectomy is independently associated with insulin resistance and T2DM.

Methods: This study included all patients aged > 20 years who had undergone cholecystectomy from 2010 to 2015 (n=55,166) and age- and sex-matched control subjects without cholecystectomy (n=110,332) using the National Health Insurance Service database. They were followed up until the date of newly developed T2DM or study end and the incidence of T2DM was traced over a maximum observation period of 7 years.

Results: Overall, 55,166 patients who underwent cholecystectomy and 110,332 age- and sex-matched controls were followed up for approximately 4.7 years, during which, incident T2DM occurred in 5,982 (3.61%) patients. Cholecystectomy was associated with 20% higher risk of T2DM after adjustment for all covariates. The cumulative incidence of T2DM also significantly increased in the cholecystectomy group for approximately 7 years (P<0.001). The adjusted hazard ratio (HR) for T2DM was the highest in the group with both cholecystectomy and obesity using the control without both cholecystectomy and obesity as a reference (HR=1.41, 95% confidence interval [CI]: 1.29-1.56). The group with cholecystectomy without obesity showed comparable risk of incident T2DM compared with the group without cholecystectomy with obesity (HR=1.29, 95% CI: 1.20-1.40 for cholecystectomy without obesity and HR=1.24, 95% CI: 1.14-1.36 for control with obesity).

Conclusions: This results provide evidence that cholecystectomy is associated with an increased risk of newly developed T2DM in Korean population. Further research is required to elucidate the mechanism of the association between cholecystectomy and incident diabetes.