ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1614287
This article is part of the Research TopicNutrient Metabolism and Complications of Type 2 Diabetes MellitusView all 11 articles
Vitamin D Deficiency and Diabetic Retinopathy Risk in Patients with Newly Diagnosed Type 2 Diabetes Mellitus: A Retrospective Analysis
Provisionally accepted
- 1Chi Mei Medical Center, Tainan, Taiwan
- 2E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
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Background: Vitamin D deficiency (VDD) has emerged as a potential contributor to diabetic complications. This study aimed to investigate the association between VDD at the time of type 2 diabetes mellitus (T2DM) diagnosis and subsequent risk of developing diabetic retinopathy (DR).Methods: This retrospective cohort study used data from the TriNetX Research Network to analyze adult patients newly diagnosed with T2DM between January 2020 and December 2022. The patients were classified as vitamin D-deficient (<20 ng/mL) or sufficient (≥30 ng/mL). After 1:1 propensity score matching, 10,651 patients were included in each group. The primary outcome was the risk of DR within three years of T2DM diagnosis. The secondary outcomes included hospitalization, emergency department visits, pneumonia, and all-cause mortality. An exploratory analysis was also conducted to examine outcomes in patients with vitamin D insufficiency (20-30 ng/mL) compared to the sufficient group.Results: At the 3-year follow-up, VDD was significantly associated with an increased risk of DR (hazard ratio[HR] 1.45, 95% confidence interval[CI] 1.17-1.80, p<0.001), hospitalization (HR 1.23, 95% CI 1.17-1.29, p<0.001), emergency department visits (HR 1.17, 95% CI 1.11-1.24, p<0.001), pneumonia (HR 1.18, 95% CI 1.07-1.31, p=0.001), and mortality (HR 1.51, 95% CI 1.36-1.67, p<0.001). Sex-stratified analysis revealed that the association between VDD and DR was significant among female patients (HR 1.41, 95% CI 1.07-1.86, p=0.015) but not among males. Exploratory analysis showed that vitamin D insufficiency (20-30 ng/mL) was not associated with increased DR risk, suggesting a threshold effect.Conclusion: In newly diagnosed T2DM patients, VDD was independently associated with increased risks of DR and other adverse outcomes, particularly in females. The observed threshold effect suggests that maintaining vitamin D levels above the deficiency threshold may be sufficient to mitigate DR risk. Assessment of vitamin D status may be valuable for risk stratification in newly diagnosed T2DM, and addressing VDD may represent a modifiable risk factor for improving outcomes.
Keywords: Vitamin D Deficiency, Diabetic Retinopathy, type 2 diabetes mellitus, Propensity score matching, Risk factors
Received: 18 Apr 2025; Accepted: 16 May 2025.
Copyright: © 2025 Hung, Chang, Chang, Ho, Wu, Liu and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: I-Wen Chen, Chi Mei Medical Center, Tainan, Taiwan
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