{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:51:18Z","timestamp":1793213478608,"version":"4.5.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted on 507 T2DM patients, divided into normal albumin (ACR &amp;lt; 30 mg\/g, n=349) and albuminuria groups (ACR \u2265 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 &amp;lt; 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 &amp;lt; 0.001), with the highest rate in moderate albuminuria subgroup (96.8%). ACR levels were significantly negatively correlated with 25-OH-VD levels(\u03c1=-0.326, P &amp;lt; 0.001). Vitamin D deficiency and elevated HbA1c had a significant positive synergistic effect on albuminuria (multivariate OR\u00a0=\u00a01.392, 95%CI:1.081~1.789, P\u00a0=\u00a00.010; univariate OR\u00a0=\u00a01.426, 95%CI:1.103~1.842, P\u00a0=\u00a00.007). Age, BMI, HbA1c, 25-OH-VD, LDL-C, eGFR, and the vitamin D deficiency \u00d7 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1818376","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T04:24:38Z","timestamp":1782793478000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Vitamin D deficiency and metabolic disorders increase albuminuria risk in type 2 diabetes (ACR 0.1\u2013300 mg\/g): a nomogram-based stratification"],"prefix":"10.3389","volume":"17","author":[{"given":"Yanmei","family":"Lin","sequence":"first","affiliation":[{"name":"Fujian Medical University Xiamen Humanity Hospital","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenru","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Qingdao Central Hospital, University of Health and Rehabilitation Sciences","place":["Qingdao, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kang","family":"Du","sequence":"additional","affiliation":[{"name":"Zoe Soft Co. Ltd.","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianqing","family":"Tian","sequence":"additional","affiliation":[{"name":"Fujian Medical University Xiamen Humanity Hospital","place":["Xiamen, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms242015485","article-title":"The role of vitamin D and its molecular bases in insulin resistance, diabetes, metabolic syndrome, and cardiovascular disease: state of the art","volume":"24","author":"Argano","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3390\/nu16234072","article-title":"Vitamin D supplementation as a therapeutic strategy in autoimmune diabetes: insights and implications for LADA 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