{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T08:07:09Z","timestamp":1784102829271,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"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. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Diabetic kidney disease (DKD) is a nutrition-related complication of type 2 diabetes mellitus (T2DM) characterized by complex disturbances in glucose, lipid, purine, and protein-related metabolism. This study aimed to investigate nutrient metabolic heterogeneity across renal stages in patients with T2DM and DKD, with particular focus on time in range (TIR), serum uric acid (SUA), TG\/HDL-C ratio, and serum albumin (ALB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center cross-sectional study included 589 hospitalized patients with T2DM, including 128 patients without DKD and 461 patients with DKD. DKD patients were further stratified according to KDIGO eGFR categories. Continuous glucose monitoring-derived TIR, SUA, TG\/HDL-C ratio, and ALB were evaluated as multidimensional nutrient metabolism indicators. Multivariable logistic regression analyses were performed to identify independent metabolic indicators associated with DKD. Renal-stage trend analyses and stratified analyses in G3 and G5 were further conducted to explore stage-specific metabolic patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with patients without DKD, patients with DKD were older, had longer diabetes duration, and showed greater use of glucose-lowering and lipid-lowering medications. Patients with DKD also showed paradoxically higher TIR levels. In the overall multivariable model, higher TIR was associated with lower odds of DKD (OR\u202f=\u202f0.97, 95% CI: 0.95\u20130.99,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.010), whereas higher SUA (OR\u202f=\u202f1.21, 95% CI: 1.08\u20131.31,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and TG\/HDL-C ratio (OR\u202f=\u202f1.27, 95% CI: 1.08\u20131.40,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.002) were associated with higher odds of DKD. Higher ALB was associated with lower odds of DKD (OR\u202f=\u202f0.91, 95% CI: 0.87\u20130.96,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Across renal stages, TIR decreased from G1 to G4, whereas SUA and TG\/HDL-C ratio increased progressively with worsening renal function. ALB showed the lowest level in G5. In stratified analyses, TIR, SUA, and TG\/HDL-C ratio remained significantly associated with DKD in G3, while ALB was the only significant metabolic correlate in G5.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>DKD in T2DM is characterized by stage-specific nutrient metabolic heterogeneity involving glucose, purine, lipid, and protein-related nutritional metabolism. G3 may represent a renal stage characterized by more prominent glucose, uric acid, and lipid metabolic abnormalities, whereas G5 may be characterized by more evident nutritional deterioration. These findings should be interpreted as stage-specific associations rather than causal progression pathways because of the cross-sectional design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.chictr.org.cn\/bin\/home<\/jats:ext-link>\n                      , identifier ChiCTR2500111406.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1885766","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T07:42:26Z","timestamp":1784101346000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Nutrient metabolic heterogeneity across renal stages in patients with type 2 diabetes mellitus and diabetic kidney disease"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiaji","family":"Hang","sequence":"first","affiliation":[{"name":"Department of Endocrinology, The Affiliated Hospital of Yangzhou University, Yangzhou University","place":["Yangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Like","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The Affiliated Hospital of Yangzhou University, Yangzhou University","place":["Yangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerong","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The Affiliated Hospital of Yangzhou University, Yangzhou University","place":["Yangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongli","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The Affiliated Hospital of Yangzhou University, Yangzhou University","place":["Yangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The Affiliated Hospital of Yangzhou University, Yangzhou University","place":["Yangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"472","DOI":"10.3390\/medicina58040472","article-title":"Recent advances in the treatment of insulin resistance targeting molecular and metabolic pathways: fighting a losing battle?","volume":"58","author":"Wolosowicz","year":"2022","journal-title":"Medicina"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1186\/s12902-024-01698-y","article-title":"Relationship between bone turnover markers and renal disease in elderly patients with type 2 diabetes: a cross-sectional 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