Lu J, Wang S, Li M, et al. - This inquiry was performed among normoglycemic Chinese adults to investigate the link of serum bile acid (BA) profile and coregulation with the risk of developing type 2 diabetes mellitus (T2DM). From the China Cardiometabolic Disease and Cancer Cohort (4C) Study, incorporating 54,807 normoglycemic Chinese adults with a median observation of 3.03 years, 1,707 individuals with incident diabetes and 1,707 controls matched by propensity score (including age, gender, BMI, and fasting glucose) were included, and among these participants, 23 serum BA species were tested. Multivariable-adjusted logistic regression analysis revealed an inverse correlation of per SD increase of unconjugated primary and secondary BAs with incident diabetes, with an odds ratio of 0.89, 0.90, and 0.90 for cholic acid, chenodeoxycholic acid, and for deoxycholic acid, respectively. Positive links with incident diabetes were shown by conjugated primary BAs (glycocholic acid, taurocholic acid, glycochenodeoxycholic acid, taurochenodeoxycholic acid, and sulfated glycochenodeoxycholic acid) and secondary BA (tauroursodeoxycholic acid). Overall, the presence of novel alterations in BAs prior to incident T2DM was evident herein, and a potential role of BA metabolism in diabetes pathogenesis is supported.