Abstract 401: Altered Bile Acid Profiles With Colesevelam Treatment Are Associated With Improved Glycemic Control in Type 2 Diabetes

Bile acid sequestrants (BAS) such as colesevelam are effective therapies for lowering LDL-cholesterol and improving glycemic control in individuals with type 2 diabetes. It is however not clear if changes in glucose metabolism with BAS treatment are regulated via changes in whole body BA metabolism. We performed a post-hoc analysis of circulating bile acid levels to investigate whether changes in glucose and lipid parameters are associated with alterations in plasma bile acids (BA) concentrations with colesevelam treatment. Subjects with type 2 diabetes (n=49) treated with diet and exercise, sulfonylurea, metformin or a combination thereof, were treated with 3.75 g/day colesevelam for 12 weeks. Fasting bile acid concentrations were measured by LC/MS and glucose and lipid kinetics were measured using stable isotope techniques at baseline and post-treatment. Colesevelam treatment reduced fasting LDL-cholesterol and increased HDL-cholesterol and triglyceride concentrations. No changes were seen in fasting total cholesterol concentrations and de novo lipogenesis (DNL). Beta-cell function (HOMA-B), glycolytic disposal of oral glucose and fasting plasma glucose clearance improved significantly. Colesevelam treatment resulted in a smaller (-40% from baseline) and more hydrophilic fasting plasma BA pool. All BA’s measured except for cholic acid, glycocholic acid and taurocholic acid decreased with treatment. Changes in total BA concentrations were inversely correlated with changes in A1C and a positive correlation was seen with fasting insulin concentrations. Changes in BA concentrations did not correlated with changes in lipid parameters. These data suggest that altered bile acids levels may contribute to improved glycemic control with colesevelam treatment in subjects with type 2 diabetes.