Background: Diabetic retinopathy (DR) is one of the diabetic microvascular complications,
which is also one of the important causes of blindness in adults.
Objective: To investigate the association between proliferative retinopathy and serum bile acid level
in patients with type 2 diabetes mellitus (T2DM).
Methods: Three hundred and thirty-six patients with T2DM were included, of which, 229 had a history
of more than 10 years without diabetic retinopathy (no diabetic retinopathy, NDR) and 107
had proliferative diabetic retinopathy (PDR). The baseline characteristics of the two groups were
compared. According to the level of bile acid, the patients were divided into low, medium and high
bile acid groups. The ratio of proliferative retinopathy in each group was compared. The presence
of retinopathy was taken as the dependent variable, and the significant variables were analyzed by
Results: The level of total bilirubin and bile acid in the NDR group was significantly higher than
that in the PDR group, while the levels of triglyceride, cholesterol and LDL-C were significantly
lower than that in the PDR group (P<0.05). With the increase of bile acid level, the proportion of
proliferative retinopathy decreased. Logistic regression analysis showed that bilirubin and bile acid
were protective factors of diabetic retinopathy, while SBP, LDL-C and UAER were risk factors of
Conclusion: Bile acid might be a protective factor for diabetic retinopathy in T2DM, which might
be a potential therapeutic role in retinal disorders.