European Journal of Cardiovascular Medicine

Cholelithiasis is a common biliary pathology with global prevalence and is often associated with metabolic risk factors including obesity, insulin resistance, and diabetes mellitus [3]. The gallbladder wall, typically measuring less than 3 mm in fasting adults, can thicken in response to both local inflammation and systemic diseases [2]. Ultrasonographic evaluation of gallbladder wall thickness (GBWT) is a reliable, non-invasive method widely used in routine abdominal imaging to assess for cholecystitis, gallstones, and structural changes [4].

Diabetes mellitus, particularly Type 2, is associated with autonomic neuropathy, which may impair gallbladder motility and delay emptying, leading to biliary stasis and sludge formation. These physiological changes predispose diabetic individuals to gallstone formation and gallbladder wall thickening even in the absence of acute cholecystitis [1,5]. Additionally, chronic hyperglycemia contributes to microvascular changes and low-grade inflammation, which may further influence gallbladder morphology.

Although cholelithiasis is prevalent in both diabetic and non-diabetic populations, limited studies have compared gallbladder wall thickness between the two groups in a structured, multicentric setting [1,5]. Furthermore, the impact of glycemic control on GBWT remains under-investigated.

This multicentric observational study was undertaken to assess and compare gallbladder wall thickness in diabetic and non-diabetic patients with ultrasonographically confirmed cholelithiasis. Furthermore, it aimed to evaluate the relationship between glycemic control and GBWT in diabetic individuals, thereby exploring the potential influence of metabolic factors on gallbladder pathology.

This was a comparative observational study conducted over a period of seven months, from November 2023 to May 2024, across two tertiary care institutions in Telangana, India: the Department of Radiodiagnosis, Gandhi Medical College, Secunderabad and the Department of Radiodiagnosis, Government Medical College, Kamareddy.

A total of 100 adult patients diagnosed with cholelithiasis on ultrasonography were enrolled after obtaining informed consent. The participants were divided into two equal groups:

Group A (Diabetic group): 50 patients with a known diagnosis of diabetes mellitus (Type 1 or Type 2).

Group B (Non-diabetic group): 50 patients without diabetes, serving as controls.

Inclusion criteria:

• Adult patients aged 18 years and above.
• Confirmed diagnosis of cholelithiasis on ultrasonography.
• For the diabetic group, documented diagnosis of diabetes mellitus with available HbA1c values within the past 3 months.

Exclusion criteria:

• Acute cholecystitis or other acute abdominal conditions.
• Known chronic liver disease, heart failure, or renal failure.
• History of gallbladder surgery or malignancy.
• All ultrasound examinations were performed using high-resolution real-time B-mode ultrasound machines with a 3–5 MHz curvilinear transducer. Gallbladder wall thickness (GBWT) was measured in the fasting state, at the anterior wall, in longitudinal and transverse planes. A thickness of >3 mm was considered abnormal. Additional findings such as sludge, pericholecystic fluid, and contracted gallbladder were also noted.
• In the diabetic group, HbA1c values were recorded to assess glycemic control, and a subgroup analysis was conducted:
• Good control: HbA1c ≤ 8%
• Poor control: HbA1c > 8%

All data were compiled and analyzed using descriptive statistics and appropriate tests of significance. A p-value of <0.05 was considered statistically significant.

A total of 100 patients with ultrasonographically confirmed cholelithiasis were enrolled in this multicentric observational study, comprising 50 diabetic and 50 non-diabetic individuals.

The mean age of diabetic patients was significantly higher (56.2 ± 8.1 years) compared to the non-diabetic group (49.6 ± 10.3 years). The gender distribution was similar in both groups, with a slightly higher proportion of females (Table 1).

Table 1: Demographic Distribution of Study Participants

Ultrasound evaluation revealed a statistically significant increase in gallbladder wall thickness (GBWT) among diabetic patients (mean: 4.6 ± 1.2 mm) compared to non-diabetic individuals (mean: 3.2 ± 0.9 mm), with a p-value <0.001. Additionally, abnormal GBWT (defined as >3 mm) was observed in 76% of diabetic patients versus 34% in non-diabetics (p < 0.001) (Table 2).

Table 2: Gallbladder Wall Thickness Comparison Between Groups

Analysis of additional sonographic findings showed that sludge was significantly more prevalent in diabetic patients (24%) compared to non-diabetics (10%) (p = 0.04).

Although pericholecystic fluid and contracted gallbladder were more common in diabetics, the differences were not statistically significant (Table 3).

Table 3: Additional Sonographic Findings

A subgroup analysis among diabetic patients demonstrated that those with poor glycemic control (HbA1c > 8%) had significantly higher GB wall thickness (5.1 ± 1.1 mm) than those with better glycemic control (HbA1c ≤ 8%) with a p-value of 0.002, indicating a positive correlation between poor glycemic control and GBWT (Table 4).

Table 4: Gallbladder Wall Thickness by Glycemic Control (Diabetic Group Only)

The present multicentric observational study evaluated gallbladder wall thickness (GBWT) in diabetic and non-diabetic patients with cholelithiasis using ultrasonography. A significant increase in mean GBWT was observed in diabetic patients, supporting the hypothesis that diabetes mellitus contributes to gallbladder wall alterations. These findings are in agreement with recent advancements in ultrasonographic evaluation that highlight wall thickening as a key marker of gallbladder dysfunction and chronic inflammation, especially in systemic conditions such as diabetes mellitus [6].

Increased GBWT in diabetics (4.6 ± 1.2 mm) compared to non-diabetics (3.2 ± 0.9 mm) may be attributed to diabetic autonomic neuropathy, which impairs gallbladder motility and results in biliary stasis. Such stasis can lead to wall edema, sludge formation, and chronic cholecystopathy, even in the absence of acute cholecystitis [8,10]. Our findings are consistent with intraoperative and radiologic studies reporting more frequent gallbladder wall thickening, adhesions, and chronic changes in diabetic patients undergoing cholecystectomy [8].

The higher prevalence of biliary sludge in diabetics (24% vs. 10%) is also noteworthy and reflects impaired gallbladder emptying, aligning with prior studies describing metabolic dysfunction-associated gallstone disease [11]. Although contracted gallbladder and pericholecystic fluid were more common in diabetics, these findings were not statistically significant, which may be due to the modest sample size.

Notably, subgroup analysis revealed that poor glycemic control (HbA1c > 8%) was associated with significantly thicker gallbladder walls, indicating a possible dose-response relationship between hyperglycemia and gallbladder wall remodeling. Similar associations between poor metabolic control and gallbladder changes have been reported in studies of both human and veterinary subjects, reinforcing the relevance of wall thickness as a sensitive marker [7,9].

Ultrasonographic measurement of GBWT remains an accessible, non-invasive tool that can aid in early detection of gallbladder abnormalities in high-risk populations. With the aging population and rising incidence of diabetes, routine screening for GBWT may improve risk stratification and surgical planning, especially in elderly patients with symptomatic cholelithiasis [12].

This multicentric observational study highlights a significant association between diabetes mellitus and increased gallbladder wall thickness (GBWT) in patients with cholelithiasis. Diabetic patients demonstrated higher mean GBWT and a greater frequency of abnormal thickening compared to non-diabetics. The presence of biliary sludge was also more common among diabetics, indicating impaired gallbladder motility. Notably, poor glycemic control correlated with greater wall thickening, suggesting that chronic hyperglycemia may contribute to gallbladder pathology. Ultrasonographic evaluation of GBWT can serve as a useful, non-invasive tool for identifying early gallbladder changes in diabetic patients. Timely diagnosis may aid in better clinical management and reduce the risk of complications.

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