title: A population-based cohort study of symptomatic gallstone disease in diabetic patients.
abstract: OBJECTIVE
  To investigate the prevalence of gallstone disease (GSD) and to evaluate the risk of symptomatic GSD among diabetic patients.
  
  
  METHODS
  The study was conducted by analyzing the National Health Research Institutes (NHRI) dataset of ambulatory care patients, inpatient claims, and the updated registry of beneficiaries from 2000 to 2008. A total of 615,532 diabetic patients without a prior history of hospital treatment or ambulatory care visits for symptomatic GSD were identified in the year 2000. Age- and gender-matched control individuals free from both GSD and diabetes from 1997 to 1999 were randomly selected from the NHIR database (n = 614,871). The incidence densities of symptomatic GSD were estimated according to the subjects' diabetic status. The distributions of age, gender, occupation, income, and residential area urbanization were compared between diabetic patients and control subjects using Cox proportion hazards models. Differences between the rates of selected comorbidities were also assessed in the two groups.
  
  
  RESULTS
  Overall, 60,734 diabetic patients and 48,116 control patients developed symptomatic GSD and underwent operations, resulting in cumulative operation rates of 9.87% and 7.83%, respectively. The age and gender distributions of both groups were similar, with a mean age of 60 years and a predominance of females. The diabetic group had a significantly higher prevalence of all comorbidities of interest. A higher incidence of symptomatic GSD was observed in females than in males in both groups. In the control group, females under the age of 64 had a significantly higher incidence of GSD than the corresponding males, but this difference was reduced with increasing age. The cumulative incidences of operations for symptomatic GSD in the diabetic and control groups were 13.06 and 9.52 cases per 1000 person-years, respectively. Diabetic men exhibited a higher incidence of operations for symptomatic GSD than did their counterparts in the control group (12.35 vs 8.75 cases per 1000 person-years).
  
  
  CONCLUSIONS
  The association of diabetes with increased symptomatic GSD may provide insight to the treatment or management of diabetes in clinical settings.
authors.affiliation: Department of Medical Research and Education, Division of General Surgery, Cheng-Hsin General Hospital, Taipei 11220, Taiwan, China. ulink@service-top1.com
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Liu
authors.forename: Chung-Te
authors.initials: CT
authors.lastname: Hsu
authors.forename: Chung-Yi
authors.initials: CY
authors.lastname: Li
authors.forename: Chu-Chieh
authors.initials: CC
authors.lastname: Chen
authors.forename: Meng-Lun
authors.initials: ML
authors.lastname: Liu
authors.forename: Jorn-Hon
authors.initials: JH
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D042882:Gallstones / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013624:Taiwan / Q000453:epidemiology