Bidirectional causal links between diabetes mellitus and autoimmune liver diseases: Insights from Mendelian randomization

IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Haixia Kuang, Jian Wu, Tao Huang, Kai Yan, Xiaoyun Hu, Ying Wu, Yudi Wang, Zhihong Wu, Xiao Chen, Gaole Yuan
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Abstract

Background

Diabetes, a growing global public health issue, is often associated with autoimmune liver diseases (AILD), such as autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC), in both type 1 diabetes (T1DM) and type 2 diabetes (T2DM). However, the causal relationship between these conditions remains unclear.

Methods

We used two-sample bidirectional Mendelian randomization (MR) to explore causal links between AILD and diabetes. Genetic variants identified from genome-wide association studies were used as instruments. Sensitivity and multivariable analyses adjusted for potential confounders were performed to assess the robustness of findings.

Results

Genetically predicted PBC (OR 1.41, 95% CI 1.19–1.67) and PSC (OR 1.39, 95% CI 1.14–1.68) were associated with an increased risk of T1DM. PBC (OR 1.03, 95% CI 1.01–1.05) was also linked to a higher risk of T2DM. In reverse MR analysis, genetically predicted T1DM was associated with an increased risk of PBC (OR 1.28, 95% CI 1.09–1.50), PSC (OR 1.27, 95% CI 1.14–1.41), and AIH (OR 1.13, 95% CI 1.06–1.19). Multivariable MR confirmed the causal effect of PBC and PSC on T1DM, but the link between PBC and T2DM weakened after adjusting for BMI and inflammatory bowel disease.

Conclusions

This study identifies bidirectional causal relationships between PBC/PSC and T1DM, suggesting shared pathogenesis, and T1DM also raises the risk for AIH. Although the link between PBC and T2DM weakened after adjusting for confounders, it highlights the complexity of genetic and environmental interactions, underscoring the importance of diabetes screening in AILD patients and guiding potential targeted therapies.

Abstract Image

糖尿病和自身免疫性肝病之间的双向因果关系:孟德尔随机化的见解
背景:糖尿病是一个日益严重的全球公共卫生问题,通常与自身免疫性肝病(AILD)相关,如自身免疫性肝炎(AIH)、原发性胆道炎(PBC)和原发性硬化性胆管炎(PSC),在1型糖尿病(T1DM)和2型糖尿病(T2DM)中均存在。然而,这些情况之间的因果关系尚不清楚。方法:采用双样本双向孟德尔随机化(MR)方法探讨糖尿病与AILD之间的因果关系。从全基因组关联研究中鉴定的遗传变异被用作工具。对潜在混杂因素进行敏感性和多变量分析,以评估研究结果的稳健性。结果:遗传预测PBC (OR 1.41, 95% CI 1.19-1.67)和PSC (OR 1.39, 95% CI 1.14-1.68)与T1DM风险增加相关。PBC (OR 1.03, 95% CI 1.01-1.05)也与T2DM的高风险相关。在反向MR分析中,遗传预测的T1DM与PBC (OR 1.28, 95% CI 1.09-1.50)、PSC (OR 1.27, 95% CI 1.14-1.41)和AIH (OR 1.13, 95% CI 1.06-1.19)的风险增加相关。多变量MR证实了PBC和PSC对T1DM的因果影响,但在调整BMI和炎症性肠病后,PBC和T2DM之间的联系减弱。结论:本研究确定PBC/PSC与T1DM之间存在双向因果关系,提示有共同的发病机制,T1DM也会增加AIH的风险。虽然在调整混杂因素后PBC和T2DM之间的联系减弱,但它强调了遗传和环境相互作用的复杂性,强调了在AILD患者中进行糖尿病筛查和指导潜在靶向治疗的重要性。
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来源期刊
Journal of Diabetes Investigation
Journal of Diabetes Investigation ENDOCRINOLOGY & METABOLISM-
CiteScore
6.50
自引率
9.40%
发文量
218
审稿时长
6-12 weeks
期刊介绍: Journal of Diabetes Investigation is your core diabetes journal from Asia; the official journal of the Asian Association for the Study of Diabetes (AASD). The journal publishes original research, country reports, commentaries, reviews, mini-reviews, case reports, letters, as well as editorials and news. Embracing clinical and experimental research in diabetes and related areas, the Journal of Diabetes Investigation includes aspects of prevention, treatment, as well as molecular aspects and pathophysiology. Translational research focused on the exchange of ideas between clinicians and researchers is also welcome. Journal of Diabetes Investigation is indexed by Science Citation Index Expanded (SCIE).
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