Zhan YH, Zhang XF. Letter to the Editor: Serum bile acid profiling for diabetic gastrointestinal neuropathy: Promise and pitfalls. World J Diabetes 2026; 17(8): 117130 [DOI: 10.4239/wjd.117130]
Corresponding Author of This Article
Xian-Feng Zhang, Department of Endocrinology & Metabolism, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, No. 261 Huansha Road, Hangzhou 310006, Zhejiang Province, China. zxf2541@zju.edu.cn
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Endocrinology & Metabolism
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letter
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Zhan YH, Zhang XF. Letter to the Editor: Serum bile acid profiling for diabetic gastrointestinal neuropathy: Promise and pitfalls. World J Diabetes 2026; 17(8): 117130 [DOI: 10.4239/wjd.117130]
World J Diabetes. Aug 15, 2026; 17(8): 117130 Published online Aug 15, 2026. doi: 10.4239/wjd.117130
Letter to the Editor: Serum bile acid profiling for diabetic gastrointestinal neuropathy: Promise and pitfalls
Yu-Hong Zhan, Xian-Feng Zhang
Yu-Hong Zhan, Xian-Feng Zhang, Department of Endocrinology & Metabolism, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Co-first authors: Yu-Hong Zhan and Xian-Feng Zhang.
Author contributions: Zhan YH reviewed the literature and write the manuscript; Zhang XF conceptualized and outlined the overall editing framework of the manuscript, and conducted a comprehensive literature review. Zhan YH and Zhang XF contributed equally to this work as co-first authors.
AI contribution statement: DeepSeek was used in polish and improve some sentences. Not any part of the manuscript (Abstract, Introduction, Materials and Methods, Results, Discussion, and Conclusion) was AI-generated. DeepSeek was used in language polishing, while there is no AI used in data analysis. AI tool participates in design of the study or interpretation of its results. There is no AI generated image in the manuscript.
Supported by Zhejiang Provincial Traditional Chinese Medicine Science and Technology Project, No. 2025ZL454; Zhejiang Provincial Medical and Health Science and Technology Program Project, No. 2025KY1092; and Construction Fund of Key Medical Disciplines of Hangzhou (Clinical Research and Evaluation), No. 2025HZGF04.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Corresponding author: Xian-Feng Zhang, Department of Endocrinology & Metabolism, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, No. 261 Huansha Road, Hangzhou 310006, Zhejiang Province, China. zxf2541@zju.edu.cn
Received: January 2, 2026 Revised: February 10, 2026 Accepted: March 2, 2026 Published online: August 15, 2026 Processing time: 249 Days and 4.5 Hours
Abstract
The study published in the World Journal of Diabetes by Zhu et al explores a critical gap in diabetic care by investigating serum bile acid (BA) profiles in diabetic gastrointestinal autonomic neuropathy (DGAN). Their analysis identifies an altered BA profile in DGAN, with taurolithocholic acid (TLCA) emerging as a key discriminator. They report that a model combining TLCA with age and fasting C-peptide achieves an exceptionally high area under the curve of 0.970 for predicting DGAN risk. This editorial appraises these compelling yet preliminary findings, acknowledging the novel link between BA dysregulation-potentially via TGR5 pathways-and DGAN pathogenesis. However, significant methodological limitations necessitate caution. The remarkably high predictive performance is likely over-optimized due to the small DGAN cohort (n = 26), and the cross-sectional design cannot establish causality. Crucially, the association is profoundly confounded by disease severity and insulin use, and the exclusion of patients on first-line therapies (metformin, GLP-1 RAs) limits generalizability. While this research posits BA profiling as a promising tool for DGAN risk stratification, it remains hypothesis-generating. The findings mandate rigorous validation in large, prospective, multi-center cohorts before any clinical application can be considered.
Core Tip: This article critically appraises a novel study linking altered bile acid profiles, specifically taurolithocholic acid, to diabetic gastrointestinal autonomic neuropathy (DGAN). While the findings are biologically plausible and suggest a promising diagnostic model, significant limitations exist. The small sample size, cross-sectional design, and confounding by disease severity and treatment necessitate caution. The results are hypothesis-generating and underscore the need for large-scale validation before this potential biomarker can be considered for clinical risk stratification of DGAN.
