Internal medicine

Microbiome

Carbohydrate metabolism

Gluconeogenesis

Diabetes mellitus

Bioinformatics

Nuclear receptor

Transcription factor

Biology

Gene

Endocrinology

Farnesoid X receptor

Type 2 diabetes

Incretin

Type 2 Diabetes Mellitus

Bile acid

Glycemic

Lipid metabolism

Metabolism

G protein-coupled bile acid receptor

Biochemistry

Medicine

The Journal of Experimental Medicine

Bile acids (BAs) are cholesterol-derived metabolites that facilitate the intestinal absorption and transport of dietary lipids. Recently, BAs also emerged as pivotal signaling molecules controlling glucose, lipid, and energy metabolism by binding to the nuclear hormone farnesoid X receptor (FXR) and Takeda G protein receptor 5 (TGR5) in multiple organs, leading to regulation of intestinal incretin secretion, hepatic gluconeogenesis, glycogen synthesis, energy expenditure, inflammation, and gut microbiome configuration. Alterations in BA metabolism and signaling are associated with obesity and type 2 diabetes mellitus (T2DM), whereas treatment of T2DM patients with BA sequestrants, or bariatric surgery in morbidly obese patients, results in a significant improvement in glycemic response that is associated with changes in the BA profile and signaling. Herein, we review the roles of BAs in glucose metabolism in health and disease; highlight the limitations, unknowns, and challenges in understanding the impact of BAs on the glycemic response; and discuss how this knowledge may be harnessed to develop innovative therapeutic approaches for the treatment of hyperglycemia and diabetes.

Bile acids in glucose metabolism in health and disease