Association Between Serum Vitamin A Levels and Long-term Outcome in Patients with T2DM
Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v7i2.5272
Abstract
Previous studies suggest that vitamin A (VA) may exert potential regulatory effects on insulin sensitivity and glucose metabolism. However, whether serum vitamin A levels influence the long-term prognosis of patients with type 2 diabetes mellitus (T2DM) remains inconclusive. This study enrolled T2DM patients with available serum VA measurements between 1999 and 2018. The all-cause mortality rate serves as the primary outcome metric. When assessing the association between mortality risk and serum vitamin A (VA) levels, the Cox proportional hazards model can be employed. Subgroups are defined according to VA levels using Kaplan-Meier (KM) analysis, followed by estimation of survival outcomes. Restricted cubic spline (RCS) regression was employed to depict the nonlinear associations between serum VA levels and mortality risk. A total, 3,681 T2DM subjects were enrolled in the final analysis, with a mean serum VA concentration of 2.12 ± 0.76 μmol/L. During the follow-up period of patients, the overall all-cause mortality rate hit 36.70%. In unadjusted Cox regression, Elevated serum vitamin A levels were notably linked to an elevated risk of death, with an HR of 1.43 and a 95% CI of 1.33–1.53. After accounting for potential confounding variables, independent association between serum VA and mortality persisted (HR = 1.12, 95% CI: 1.03–1.22). Subjects with serum VA concentrations above 2.09 μmol/L exhibited significantly poorer survival than those below this threshold (P < 0.01). Moreover, RCS modeling revealed a U-shaped pattern linking serum VA levels to mortality risk. Blood vitamin A levels are notably associated with long-term mortality in individuals with type 2 diabetes, and our research findings necessitate further validation in other population groups.
Keywords
vitamin A, NHANES, diabetes mellitus, mortality
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[2] REN Y, YANG B W, SUN Y M, et al. Mendelian randomization study on the correlation between micronutrients and type 2 diabetes mellitus and its complications[J]. Chinese Nursing Research, 2025, 17: 2849-2858.
[3] WANG H, SHEN Y, DU Y F, et al. Serum Vitamin Levels and Its Influencing Factors in Patients with Type 2 Diabetes Mellitus[J]. Medical Journal of the Chinese People's Armed Police Forces, 2024, 1: 34-37,43. DOI:10.3969/j.issn.1004-3594.2024.01.008.
[4] ZHAO P T. Dietary Analysis and Nutritional Treatment Effect Study of Gestational Diabetes Mellitus Patients with Pre-pregnancy Overweight and Obesity[D]. Qingdao University, 2021.
[5] SHI Y H, JING Z H, YANG F M. Relationship between changes of serum RBP4, BMP2 levels and osteoporosis in middle-aged and elderly male patients with T2DM[J]. Chinese Journal of Gerontology, 2022, 12: 2890-2892. DOI:10.3969/j.issn.1005-9202.2022.12.011.
[6] KUANG YANPING, WANG LINJING, ZHONG SHUTING, et al. Analysis of Serum Vitamin and Immune Levels in Patients with Type 2 Diabetes Complicated with Infection and Clinical Nursing Research[J]. Journal of Nurses Training, 2012, 27(04):299-301. DOI:10.3969/j.issn.1002-6975.2012.04.004.
[7] HAN LEI, ZHANG PEIHUA, LI HUI, LI YUAN, BI SHULIAN. Detection of Serum Vitamin A Levels in Patients with Type 2 Diabetes Mellitus[J]. Journal of Precision Medicine, 2003(3):287-288.
[8] XU LEI. Supplementing Vitamin A Improves Pancreatic Islet Function[J]. Health and Life, 2017(10):57.
[9] LI TIANSHUANG, WANG MINGTING, GU MAOHONG, et al. Analysis of Nutritional Status, Serum Vitamin A and Retinol Binding Protein 4 Levels in Patients with Gestational Diabetes Mellitus During Pregnancy[J]. Journal of Southeast University (Medical Science Edition), 2020, 39(2):163-168. DOI:CNKI:SUN:NJTD.0.2020-02-006.
[10] LAI XIANGMEI, WANG FEE, ZENG SHENGLAN. Effects of Supplementing Vitamins A, D and E on Blood Glucose and Blood Lipid Related Indicators in Patients with Gestational Diabetes Mellitus[J]. Clinical Medicine, 2020, 40(10):83-86. DOI:10.19528/j.issn.1003-3548.2020.010.034.
[11] ZHANG HUI, CHEN XIAOYAN, HUANG XIAOCHUN, et al. Study on the Relationship Between Vitamin A Deficiency and Chronic Complications of Diabetes Mellitus[J]. New Medicine, 2010(10):668-670. DOI:10.3969/j.issn.0253-9802.2010.10.014.
[12] HE J Q, ZHOU Q, ZENG J, et al. Study on dietary status of patients with type 2 diabetes mellitus and its correlation with blood glucose control[J]. South China Journal of Preventive Medicine, 2017, 43(2): 117-121. DOI:CNKI:SUN:GDWF.0.2017-02-004.
[13] LI P W. Clinical Study on the Correlation Between Serum Retinol-Binding Protein 4 and Diabetic Retinopathy in Type 2 Diabetes Mellitus[D]. Zhengzhou: Zhengzhou University, 2018. DOI: CNKI:CDMD:2.1018.107091.
[14] WANG Q Q, ZHANG A Z. A Comparative Study on Vitamin A and Vitamin E Intake in Self-Designed Diets of Patients with Type 2 Diabetes Mellitus[J]. Zhejiang Medical Journal, 2002, 24(3): 133-134. DOI: 10.3969/j.issn.1006-2785.2002.03.002.
[15] PITTAS A G, DAWSON-HUGHES B, SHEEHAN P, et al. Vitamin D supplementation and prevention of type 2 diabetes[J]. New England journal of medicine, 2019, 381(6): 520-530.
[16] DAS U N. Vitamin C for type 2 diabetes mellitus and hypertension[J]. Archives of medical research, 2019, 50(2): 11-14.
[17] FUENTES-BARRÍA H, AGUILERA-EGUÍA R, FLORES-FERNÁNDEZ C, et al. Vitamin D and type 2 diabetes mellitus: molecular mechanisms and clinical implications—a narrative review[J]. International Journal of Molecular Sciences, 2025, 26(5): 2153.
[18] SU GUANXUN, WANG SHIDONG, LI JIAYUE, et al. Study on Risk Factors of Cardiac Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus[J]. Chongqing Medicine, 2024, 53(3):333-338. DOI:10.3969/j.issn.1671-8348.2024.03.003.
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[20] YU DANDAN, ZHOU XUELING, NIU DIEJING, et al. Study on the Correlation Between Plasma Osteopontin Level and Mild Cognitive Impairment in Patients with Type 2 Diabetes Mellitus[J]. National Medical Journal of China, 2024, 104(38):3593-3599. DOI:10.3760/cma.j.cn112137-20240505-01041.
[21] HUANG LI, PAN JIAYUE (Review), YANG YANG (Reviewer). Research Progress on the Mechanism of IGF-1 in Type 2 Diabetes Mellitus and Type 2 Diabetic Nephropathy[J]. Journal of Difficult and Complicated Cases, 2024, 23(2):253-256.
[22] LIU HUAN, HAN PINGPING, SUN LIN, et al. Correlation Between Serum Uric Acid Within Normal Range and Peripheral Neuropathy in Patients with Type 2 Diabetes Mellitus[J]. Journal of Clinical Internal Medicine, 2024, 41(2):121-123.
[23] SAYEDALI E, YALIN A E, YALIN S. Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes[J]. World journal of diabetes, 2023, 14(5): 585.
[24] OU XIAOHONG, AN BO, ZHOU SHUJING, et al. Study on the Correlation Between Serum Uric Acid Level and Morning Peak Blood Pressure in Middle-Aged and Elderly Patients with Type 2 Diabetes Complicated with New-Onset Hypertension[J]. Chinese Journal of General Practitioners, 2026, 25(05):590-594. DOI:10.3760/cma.j.cn114798-20250823-00993.
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[28] JIANG FUSONG, CHENG XINGBO, ZHANG HUI. The Value of Serum Retinol Binding Protein 4 in Type 2 Diabetic Retinopathy[J]. Chinese Journal of Diabetes Mellitus, 2010(5): 5. DOI:10.14033/j.cnki.cfmr.2010.05.005.
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