ArticleFrontiers in endocrinology2026
Vitamin D deficiency and metabolic disorders increase albuminuria risk in type 2 diabetes (ACR 0.1-300 mg/g): a nomogram-based stratification.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: This study aimed to investigate the synergistic effect of vitamin D deficiency and metabolic disorders on albuminuria in type 2 diabetes mellitus (T2DM) patients with urinary albumin-to-creatinine ratio (ACR) of 0.1~300 mg/g, and to construct a validated risk stratification nomogram for precise clinical assessment. Methods: A cross-sectional study was conducted on 507 T2DM patients, divided into normal albumin (ACR < 30 mg/g, n=349) and albuminuria groups (ACR ≥ 30 mg/g, n=158; further subdivided into micro- and moderate albuminuria subgroups). Serum 25-hydroxyvitamin D (25-OH-VD) was detected, with deficiency defined as < 50 nmol/L. Interaction analysis, univariate Logistic regression, LASSO regression and multivariate Logistic regression were used to screen core factors and identify independent predictors of albuminuria. A nomogram was constructed and validated by concordance index (C-index), calibration curves and decision curve analysis (DCA) in the total population and ACR subgroups. Results: The prevalence of vitamin D deficiency was 83.0% in all patients, and was significantly higher in the albuminuria group (91.8%) than the normal group (79.1%, P < 0.001), with the highest rate in moderate albuminuria subgroup (96.8%). ACR levels were significantly negatively correlated with 25-OH-VD levels(ρ=-0.326, P < 0.001). Vitamin D deficiency and elevated HbA1c had a significant positive synergistic effect on albuminuria (multivariate OR = 1.392, 95%CI:1.081~1.789, P = 0.010; univariate OR = 1.426, 95%CI:1.103~1.842, P = 0.007). Age, BMI, HbA1c, 25-OH-VD, LDL-C, eGFR, and the vitamin D deficiency × HbA1c interaction term were identified as independent predictors. The constructed nomogram had excellent discriminative ability (C-index: 0.882 in training set, 0.858 in validation set), with C-indices of 0.845 and 0.861 in micro- and moderate albuminuria subgroups, respectively. Calibration curves showed high consistency between predicted and actual probabilities, and DCA confirmed the nomogram had significantly higher clinical net benefit than traditional and single-index models. Conclusion: Vitamin D deficiency is highly prevalent in T2DM patients with ACR 0.1~300 mg/g and synergizes with elevated HbA1c to drive albuminuria progression. The constructed nomogram integrates key metabolic predictors and the vitamin D-HbA1c interaction term, exhibiting excellent predictive and stratification ability, and may serve as a precise tool for individualized risk assessment and stratified intervention in T2DM patients.
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