Zhang Z, Shan XQ, Liang FM, Zhang LX. Letter to the Editor: Indirect bilirubin: A potential predictive biomarker for diabetic retinopathy and its clinical translational potential. World J Diabetes 2026; 17(5): 115813 [DOI: 10.4239/wjd.v17.i5.115813]
Corresponding Author of This Article
Li-Xia Zhang, Eye Hospital, China Academy of Chinese Medical Sciences, No. 33 Lugu Road, Shijingshan District, Beijing 100040, China. zhanglixia77@126.com
Research Domain of This Article
Ophthalmology
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Correspondence
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
May 15, 2026 (publication date) through May 14, 2026
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Journal Information of This Article
Publication Name
World Journal of Diabetes
ISSN
1948-9358
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zhang Z, Shan XQ, Liang FM, Zhang LX. Letter to the Editor: Indirect bilirubin: A potential predictive biomarker for diabetic retinopathy and its clinical translational potential. World J Diabetes 2026; 17(5): 115813 [DOI: 10.4239/wjd.v17.i5.115813]
Zhao Zhang, Li-Xia Zhang, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing100040, China
Xiao-Qian Shan, Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
Feng-Ming Liang, Eye School of Chengdu University of Traditional Chinese Medicine, Chengdu 610000, Sichuan Province, China
Co-first authors: Zhao Zhang and Xiao-Qian Shan.
Author contributions: Zhang Z and Shan XQ contributed to writing review & editing and original draft, visualization, validation, resources, project administration, and research methodology; Liang FM supervised the research; Zhang LX was responsible for paper formatting and layout.
Supported by National Natural Science Foundation of China, No. 82174442.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Li-Xia Zhang, Eye Hospital, China Academy of Chinese Medical Sciences, No. 33 Lugu Road, Shijingshan District, Beijing 100040, China. zhanglixia77@126.com
Received: October 27, 2025 Revised: December 15, 2025 Accepted: December 31, 2025 Published online: May 15, 2026 Processing time: 197 Days and 17.9 Hours
Abstract
Diabetic retinopathy (DR), a major microvascular complication of type 2 diabetes mellitus (T2DM), is a leading cause of blindness and visual impairment. Elucidating risk factors for DR progression is critical in reducing the incidence of preventable blindness and enhancing patient outcomes. Recent research has highlighted an independent inverse relationship between indirect bilirubin (IBIL) levels and DR risk in a cohort of 6993 T2DM individuals. This finding underscores the potential of IBIL as an inexpensive, non-invasive biomarker for DR risk prediction with considerable translational prospects. This article synthesizes clinical and experimental evidence to evaluate the role of IBIL in DR risk prediction, discusses its potential and limitations as a predictive biomarker, and explores its integration with established risk factors as well as practical considerations for clinical implementation.
Core Tip: Diabetic retinopathy (DR) remains a leading cause of vision loss and blindness among individuals with type 2 diabetes. A critical need exists for reliable biomarkers that can facilitate early identification and diagnosis of DR, as the absence of such markers significantly impedes timely intervention and effective management. The study by Lin et al reveals that "IBIL levels are independently and inversely associated with DR risk, suggesting its potential as a low-cost, non-invasive, and readily applicable predictive biomarker". To facilitate a comprehensive understanding of this novel predictive indicator, this review first evaluates the potential of indirect bilirubin in DR risk prediction from both basic science and clinical perspectives. It subsequently addresses the advantages and challenges associated with its application as a predictive biomarker and concludes with projections on its future role in DR screening strategies.
