Aug 2026· Diabetes, obesity and metabolism· 0 citations· 36 references
Medicine
TL;DR
The metabolic phenotypes were explored in a primary care T2DM cohort, supporting their reproducibility across clinical settings and vitamin D status varied by phenotype severity, with more severe phenotypes more likely to exhibit insufficiency.
Abstract
Aims
This study aimed to perform an exploratory characterisation of metabolic phenotypes in primary care patients with type 2 diabetes mellitus (T2DM), using a predefined approach and examine their association with vitamin D status.
Materials And Methods
This cross-sectional study included 178 participants randomly selected in Sergipe, Brazil. Phenotypic clusters were derived using body mass index (BMI), glycated haemoglobin levels, age at diagnosis, insulin resistance (homeostatic model assessment (HOMA) for insulin resistance) and β-cell function (HOMA-B). To explore differences across phenotypes, we evaluated high-sensitivity C-reactive protein [hs-CRP] and serum ferritin levels, waist circumference and BMI, serum concentrations of 25-hydroxyvitamin D [25(OH)D] and therapeutic profile. Clustering was performed using the K-medoids algorithm. Group comparisons were performed using the Kruskal-Wallis and Fisher's exact tests and associations were assessed using multivariable logistic regression. A p-value of < 0.05 was considered significant.
Results
Four metabolic phenotypes were identified: two more severe clusters (severe insulin-deficient diabetes (SIDD)-like and severe insulin-resistant diabetes-like) and two milder clusters (mild obesity-related diabetes (MOD)-like and mild age-related diabetes (MARD)-like). Significant differences were observed in age, insulin use, waist circumference and fasting glucose, triglycerides and hs-CRP levels. Median 25(OH)D levels were lower in severe phenotypes compared with milder phenotypes. The SIDD-like group, characterised by marked insulin deficiency, showed 3.68-fold higher odds of vitamin D insufficiency (< 30 ng/mL) compared with the MARD-like phenotype (p = 0.013).
Conclusions
The metabolic phenotypes were explored in a primary care T2DM cohort, supporting their reproducibility across clinical settings. Vitamin D status varied by phenotype severity, with more severe phenotypes more likely to exhibit insufficiency.
Background This study investigated the associations of serum 25-hydroxyvitamin D [25(OH)D], the principal circulating marker used to assess vitamin D status, and chemerin with metabolic syndrome (MetS) components in individuals with type 2 diabetes mellitus (T2DM) and in a non-diabetic comparison group. The MetS components assessed were central obesity/waist circumference, blood pressure, fasting plasma glucose, triglycerides, and HDL-C, because these are the diagnostic elements of the International Diabetes Federation (IDF) definition. Methods This cross-sectional analytical study was conducted at King Abdulaziz University, Rabigh, between August 2021 and December 2022. Participants were classified as having MetS according to IDF criteria, and vitamin D status was classified using serum 25(OH)D concentrations as deficient, insufficient, or sufficient. Serum 25(OH)D, chemerin, and CRP were measured by ELISA. Results A total of 176 participants were included in the study (88 with diabetes and 88 non-diabetic comparison participants), with equal sex distribution in both groups (44 females and 44 males per group). Compared with the non-diabetic comparison group, participants with T2DM had significantly higher chemerin (p < 0.001) and significantly lower 25(OH)D (p < 0.001). The MetS was more common in diabetic participants than in non-diabetic comparison participants: 70/88 (79.5%) vs. 43/88 (48.9%) (p < 0.001). Blood chemerin levels were also elevated in those with MetS compared with those without MetS (p = 0.032). Within the diabetic group, 18/88 (20.5%) had 25(OH)D deficiency and 47/88 (53.4%) had insufficient levels, whereas among non-diabetic comparison participants, 7/88 (8%) had deficiency and 32/88 (36.4%) had insufficient levels (p < 0.001). Higher FPG, insulin, HOMA-IR, HbA1c, TC, and CRP were associated with lower 25(OH)D in diabetic subjects. The latter inverse relationships were also observed in the MetS subgroup. Chemerin was associated with HOMA-IR, FPG, TC, CRP, and HbA1c in diabetic subjects. In the MetS subgroup, FPG, insulin, HOMA-IR, HbA1c, TC, and CRP remained positively correlated with chemerin. The regression analysis revealed that diabetic status and female sex were independently related to 25(OH)D status. In the adjusted chemerin model, chemerin was inversely and significantly associated with 25(OH)D (B −2.451, 95% CI −3.916–−0.986, p = 0.001). Diabetes and female sex were the only variables independently associated with MetS status in the logistic regression analysis. Conclusion Individuals with T2DM showed lower serum 25(OH)D and increased chemerin concentrations than non-diabetic comparison participants. Chemerin was higher in participants with MetS, whereas neither 25(OH)D nor chemerin was independently associated with MetS in the adjusted logistic model. These findings support an association, rather than a causal or diagnostic relationship, between 25(OH)D, chemerin, and cardiometabolic disturbance in this cohort. Further longitudinal and interventional studies are required.
M. Baig, Z. Gazzaz, M. Khabaz et al.· Frontiers in Medicine· 0 citations
This study identified and temporally validated key metabolic and clinical markers associated with prevalent T2D in obese Indians using age- and sex-matched case-control analysis and demonstrated good discrimination in obese Indian individuals.
Anagha Vyawahare, Pramod Tripathi, Nidhi Kadam et al.· Frontiers in Clinical Diabet...· 0 citations
bjective: Low-grade chronic inflammation contributes to residual cardiometabolic risk in type 2 diabetes (T2DM), even among patients who achieve glycemic targets. Dietary Inflammatory Index (DII) quantifies the inflammatory potential of habitual diet; however, its association with systemic inflammatory markers in well-controlled T2DM remains unclear. This study aimed to investigate the association between DII scores and circulating inflammatory markers in adults with well-controlled T2DM.Material and Methods: This cross-sectional study included 120 adults with T2DM and 30 healthy controls. Dietary intake was assessed using a validated 7-day food frequency questionnaire, and DII scores were calculated. Patients with T2DM were stratified into DII quartiles. Serum levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and high-sensitive C-reactive protein (hs-CRP), along with metabolic parameters, were measured. Associations were evaluated using correlation and regression analyses, and effect sizes were estimated using Cohen’s d.Results: DII scores were positively correlated with IL-6 (r=0.421, p<0.001) and hs–CRP (r=0.312, p=0.002). IL 6 levels increased progressively across DII quartiles (p for trend <0.001), with a large effect size between the lowest and highest quartiles (Cohen’s d=0.84). Higher DII scores were associated with lower intakes of dietary fiber, polyunsaturated fatty acids, magnesium, and vitamin C (all p<0.05). Serum uric acid levels also increased across DII quartiles (p=0.044). No significant association was observed between DII and TNF-α.Conclusions: In adults with well-controlled T2DM, a more proinflammatory diet is associated with higher systemic inflammation, particularly elevated IL 6 levels. These findings suggest that dietary inflammatory potential may contribute to residual cardiometabolic risk beyond glycemic control.
B. Calıkoglu, Fatma Yiğiyoğlu Tümer, H. Hacisahinogullari et al.· Journal of Istanbul Faculty...· 0 citations
Introduction: Insulin resistance, dyslipidemia, and increased risk of developing cardiovascular diseases have been identified in patients with type 2 diabetes mellitus (T2DM). Triglyceride – Glucose (TyG) index has been identified as the surrogate marker for insulin resistance and vitamin D deficiency is known to contribute to poor metabolic profile. This study aimed at exploring the relation between TyG index and vitamin D and their association with cardiovascular disease risk factors in patients with T2DM.
Materials and Methods: Hospital-based cross-sectional study was carried out on 156 patients with T2DM presenting in tertiary care hospital. Anthropometry, fasting blood glucose, HbA1c, lipid profile, and serum vitamin D were determined. TyG index, Cardiac Risk Ratio (CRR), Atherogenic Coefficient (AC) and Atherogenic Index of Plasma (AIP) were calculated. Group comparisons based on vitamin D deficiency and correlations were carried out using one-way ANOVA, Chi square and Spearman’s rank correlation.
Results: The mean age of participants was 52.1 ± 10.4 years, mean BMI was 27.3 ± 3.2 kg/m², mean TyG index was 9.85 ± 0.24, and mean serum vitamin D concentration was 18.0 ± 7.3 ng/mL. Vitamin D deficiency was observed in 94 (60.3%) participants. Patients with vitamin D deficiency had higher BMI (28.6 ± 4.3 vs. 25.1 ± 3.2 kg/m²), TyG index (10.01 ± 0.25 vs. 9.63 ± 0.21), HbA1c (8.1 ± 1.6% vs. 7.5 ± 1.3%), Cardiac Risk Ratio (5.4 ± 1.7 vs. 4.5 ± 1.3), and Atherogenic Index of Plasma (0.32 ± 0.26 vs. 0.18 ± 0.20) than vitamin D-sufficient participants. One-way ANOVA demonstrated significant differences in BMI (F (2,153) = 7.58, p < 0.001), TyG index (F (2,153) = 13.42, p < 0.001), Cardiac Risk Ratio (F (2,153) = 3.40, p = 0.036), and Atherogenic Index of Plasma (F (2,153) = 3.27, p = 0.040), whereas differences in HbA1c were not statistically significant (F (2,153) = 1.55, p = 0.216). Vitamin D status showed significant associations with gender (χ² = 10.03, df = 2, p = 0.007) and BMI category (χ² = 15.44, df = 4, p = 0.004), whereas no significant association was observed with age group (χ² = 1.23, df = 4, p = 0.873). Spearman correlation analysis demonstrated that the TyG index was positively correlated with HbA1c (ρ = 0.46), Cardiac Risk Ratio (ρ = 0.52), and Atherogenic Index of Plasma (ρ = 0.61), and negatively correlated with vitamin D (ρ = −0.41) (all p < 0.001).
Conclusions: The TyG index was significantly associated with adverse glycemic and atherogenic markers and inversely associated with vitamin D levels in patients with type 2 diabetes mellitus. These findings suggest that the TyG index and vitamin D status are associated with cardiometabolic risk factors; however, the cross-sectional design precludes causal inference, and prospective studies are needed to confirm these associations.
Key words: TyG index, Vitamin D, Insulin resistance, Type 2 diabetes mellitus, Cardiovascular risk
Sweety Kumari, A. Batta, Manju Sharma et al.· International Journal of Hea...· 0 citations
Objectives
: Vitamin D deficiency has been associated with obesity, insulin resistance, chronic inflammation, and cardiovascular disease (CVD). This study aimed to evaluate the association between serum vitamin D concentrations, body mass index (BMI), and cardiometabolic risk factors in adults.
Methods
: A cross-sectional observational study was conducted among 264 adults (109 men and 155 women) aged 19–60 years (mean age, 41.19 years). Anthropometric measurements, body composition parameters, blood pressure, biochemical markers, and questionnaire-derived health information were assessed. Participants were classified according to serum 25-hydroxyvitamin D [25(OH)D] concentrations and BMI status. Statistical analyses included the χ
2
test, Fisher’s exact test, Student’s
t
-test, ANOVA, Spearman correlation analysis, and multiple linear regression.
Results
: CVD was more prevalent among participants with vitamin D deficiency than among those with sufficient vitamin D concentrations (15.9% vs. 7.1%,
p
< 0.01). Obesity (70.5% vs. 48.6%,
p
< 0.001), diabetes (8.0% vs. 4.3%,
p
< 0.001), and depression (25.0% vs. 10.0%,
p
< 0.001) were also more common in the vitamin D-deficient group. Serum 25(OH)D concentrations were inversely associated with BMI, waist circumference, waist-to-height ratio, fat mass, triglycerides, fasting insulin, HOMA-IR, and hsCRP. Serum 25(OH)D concentrations decreased significantly across BMI categories, from 48.8 nmol/L in normal-weight participants to 22.2 nmol/L in those with class III obesity (
p
< 0.001). Individuals with vitamin D deficiency had a longer history of overweight or obesity (14.95 ± 9.40 vs. 10.85 ± 6.24 years,
p
< 0.01). BMI, waist-to-height ratio, body fat percentage, and lipid ratios demonstrated the strongest predictive value for serum 25(OH)D concentrations.
Conclusion
: Vitamin D deficiency is associated with an unfavorable cardiometabolic profile characterized by increased adiposity, insulin resistance, inflammation, and a higher prevalence of CVD. The coexistence of vitamin D deficiency and excess BMI may further increase cardiometabolic risk and should be considered in preventive and clinical risk assessment strategies.
Maria Nikolova, A. Alakidi, R. Tafradjiiska-Hadjiolova et al.· Pharmacia· 0 citations
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