Why Is Diabetic Bile Lithogenic?

To the Editor: In the recent report by Bennion and Grundy entitled “Effects of Diabetes Mellitus on Cholesterol Metabolism in Man” (N Engl J Med 296:1365–1371, 1977), the authors offer several speculative explanations for the seemingly paradoxical observation that diabetic bile appears to be less lithogenic when treatment of hyperglycemia is inadequate. Another explanation that could relate hyperglycemia to gallstones might be considered. The authors studied their patients at “steady-state” conditions. If hyperglycemia precedes increased cholesterol synthesis and hyperlipoproteinemia, which in turn precede increased production of bile salts, there might be a period after a rise in blood glucose level. . . No extract is available for articles shorter than 400 words.