Systematic Review of Gallbladder Disease in Type 1 Diabetes Mellitus: Evidence on the Association With Cholecystitis

Cholecystitis is a common gastrointestinal condition strongly associated with type 2 diabetes mellitus (T2DM). However, the relationship between type 1 diabetes mellitus (T1DM) and cholecystitis is poorly defined. To date, no prior systematic review has specifically evaluated this association. This review aimed to evaluate whether T1DM is associated with cholecystitis, gallstones, or broader gallbladder disease and to identify gaps in the literature. A systematic search of Embase, Ovid Emcare, Ovid MEDLINE, and the NHS Knowledge and Library Hub was conducted (last search April 2025). Eligible studies were observational, comparing people with T1DM to nondiabetic or T2DM populations. Case reports, reviews, and studies not distinguishing between diabetes types were excluded. Risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies and the Joanna Briggs Institute checklist for cross-sectional studies. Due to heterogeneity, a qualitative synthesis was performed. Four studies met the inclusion criteria: two cross-sectional, one retrospective cohort, and one database analysis. Evidence was inconsistent. One cohort study reported a reduced gallstone risk in young adults with T1DM (adjusted hazard ratio: 0.48, 95% CI: 0.25-0.92). A pediatric study found no gallstones among 105 children with T1DM. Broader gallbladder disease outcomes showed no consistent associations after adjustment for confounders. Notably, no study specifically evaluated acute cholecystitis. Current evidence does not demonstrate a clinically significant association between T1DM and acute cholecystitis. The small number and heterogeneity of available studies limit the ability to draw firm conclusions. Further large-scale, prospective research using standardized diagnostic criteria is needed.