{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T11:22:40Z","timestamp":1787829760701,"version":"build-2784847793"},"reference-count":106,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Abnormal nocturnal dipping (ND) in diabetes mellitus is linked to adverse outcomes. Its association with vitamin D (VD), cardiovascular autonomic neuropathy (CAN), and diabetic kidney disease (DKD) remains unclear. We aim to evaluate the association of VD status with ND loss as well as CAN in type 2 diabetes mellitus (T2DM) across different DKD stages. Methods: 83 T2DM patients were included in this cross-sectional study: 36 with early-stage DKD (urine albumin-to-creatinine ratio [UACR] 30\u2013299 mg\/g; Group 1) as well as 47 with advanced-stage DKD (UACR \u2265 300 mg\/g; Group 2). Results: Patients with advanced DKD exhibited higher CAN prevalence (72.70% vs. 52.80%; p &lt; 0.05), lower 25(OH)D (26.90 \u00b1 9.90 vs. 29.60 \u00b1 8.00 ng\/mL; p = 0.05), and lower systolic ND (0.82 \u00b1 8.40 vs. 4.50 \u00b1 7%; p &lt; 0.05). Among patients with advanced DKD, lower 25(OH)D levels, classified according to the Institute of Medicine (IOM) criteria (normal \u2265 20 ng\/mL), were associated with reduced systolic ND (1.90 \u00b1 7.80 vs. \u22125.60 \u00b1 9.30%; p &lt; 0.05), while the Endocrine Society criteria showed a progressive reduction in systolic ND across VD classification (insufficiency 20\u201329.9, deficiency &lt;20, and sufficiency \u226530 ng\/mL), (\u22125.60 \u00b1 9.30 vs. \u22120.20 \u00b1 7.30 vs. 3.30 \u00b1 8%, respectively; p &lt; 0.05). Patients with definite\/severe CAN exhibited lower systolic ND (\u22124.38 \u00b1 7.41 vs. 3.34 \u00b1 8.00%; p &lt; 0.01) than those with absent\/early CAN. In addition, lower VD levels were associated with greater CAN severity according to both the Endocrine Society criteria (p &lt; 0.01, r = 0.40), and the IOM criteria (p &lt; 0.05, r = 0.30). In the regression model, VD remained an independent predictor of absence of diastolic ND (Rsqr = 0.393; p &lt; 0.05). Conclusions: These findings suggest a potential link between vitamin D status, autonomic dysfunction, and ND in patients with T2DM and advanced DKD.<\/jats:p>","DOI":"10.3390\/nu18172807","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T10:58:21Z","timestamp":1787828301000},"page":"2807","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Loss of Nocturnal Dipping in Type 2 Diabetes Mellitus According to Diabetic Kidney Disease: The Role of Vitamin D Levels"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4002-988X","authenticated-orcid":false,"given":"Jo\u00e3o Soares","family":"Fel\u00edcio","sequence":"first","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0996-3885","authenticated-orcid":false,"given":"Isabel Jacob","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3658-333X","authenticated-orcid":false,"given":"Marina Izabel Monteiro","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9293-7699","authenticated-orcid":false,"given":"Beatriz Dias","family":"Lobo","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9324-0902","authenticated-orcid":false,"given":"Maria Eduarda Nunes Avelar","family":"do Carmo","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0374-8782","authenticated-orcid":false,"given":"Alessandra Pitanga Cardoso","family":"Costa","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8721-5694","authenticated-orcid":false,"given":"Isabella Almeida","family":"Santos","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9148-1465","authenticated-orcid":false,"given":"Karem Mileo","family":"Fel\u00edcio","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6919-2931","authenticated-orcid":false,"given":"Priscila Boaventura Barbosa","family":"De Figueiredo","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0824-7767","authenticated-orcid":false,"given":"Lilian de Souza D\u2019Albuquerque","family":"Silva","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7477-2700","authenticated-orcid":false,"given":"Franciane Trindade Cunha","family":"de Melo","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6123-1553","authenticated-orcid":false,"given":"Ana Carolina Contente Braga","family":"de Souza","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0452-7451","authenticated-orcid":false,"given":"M\u00e1rcia Costa","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2125-3579","authenticated-orcid":false,"given":"Lorena Vilhena","family":"De Moraes","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, 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University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8404-3330","authenticated-orcid":false,"given":"F\u00e1bio","family":"Feij\u00f3","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3091-2126","authenticated-orcid":false,"given":"Pedro Paulo","family":"Piani","sequence":"additional","affiliation":[{"name":"Endocrinology Department, University Hospital Jo\u00e3o de Barros Barreto, Federal University of Par\u00e1, Belem 66075-110, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3396-6683","authenticated-orcid":false,"given":"Val\u00e9ria 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