Royal College of Surgeons in Ireland
Vitamin D3metabolite ratio as an indicator......pdf (1.81 MB)

Vitamin D3 metabolite ratio as an indicator of vitamin D status and its association with diabetes complications

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Version 2 2022-07-22, 09:40
Version 1 2021-12-20, 14:31
journal contribution
posted on 2022-07-22, 09:40 authored by Lina H. M. Ahmed, Alexandra E Butler, Soha R. Dargham, Aishah Latif, Omar M. Chidiac, Stephen AtkinStephen Atkin, Charbel Abi Khalil

Background: Vitamin D deficiency is diagnosed by total serum 25-hydroxyvitamin D (25(OH)D) concentration and is associated with poor health and increased mortality; however, some populations have low 25(OH) D concentrations without manifestations of vitamin D deficiency. The Vitamin D Metabolite Ratio (VMR) has been suggested as a superior indicator of vitamin D status. Therefore, VMR was determined in a population with type 2 diabetes at high risk for vitamin D deficiency and correlated with diabetic complications.

Research design and methods: Four hundred sisty patients with type 2 diabetes (T2D) were recruited, all were vitamin D3 supplement naive. Plasma concentration of 25-hydroxyvitamin D3 (25(OH)D3) and its metabolites 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) and 24,25-dihydroxyvitamin D3 (24,25(OH)2D3) and its epimer, 3-epi-25-hydroxyvitamin D3 (3-epi-25(OH)D3), were measured by LC-MS/MS analysis. VMR-1 was calculated as a ratio of 24,25(OH)2D3:25(OH)D3; VMR-2 as a ratio of 1,25(OH)2D3:25(OH)D3; VMR-3 was calculated as a ratio of 3-epi-25(OH)D3: 25(OH)D3. RESULTS: An association means that there were significant differences between the ratios found for those with versus those without the various diabetic complications studied. VMR-1 was associated with diabetic retinopathy (p = 0.001) and peripheral artery disease (p = 0.012); VMR-2 associated with hypertension (p < 0.001), dyslipidemia (p < 0.001), diabetic retinopathy (p < 0.001), diabetic neuropathy (p < 0.001), coronary artery disease (p = 0.001) and stroke (p < 0.05). VMR-3 associated with hypertension (p < 0.05), dyslipidemia (p < 0.001) and coronary artery disease (p < 0.05).

Conclusions: In this cross sectional study, whilst not causal, VMR-2 was shown to be the superior predictor of diabetic and cardiovascular complications though not demonstrative of causality in this cross-sectional study population over VMR-1, VMR-3 and the individual vitamin D concentration measurements; VMR-2 associated with both microvascular and cardiovascular indices and therefore may have utility in predicting the development of diabetic complications.


Qatar National Research Fund (QNRF), NPRP Grant 9–169–3-024



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Published Citation

Ahmed LHM. et al. Vitamin D3 metabolite ratio as an indicator of vitamin D status and its association with diabetes complications. BMC Endocr Disord. 2020;20(1):161.

Publication Date

27 October 2020

PubMed ID



  • RCSI Bahrain


BioMed Central


  • Published Version (Version of Record)