Type 2 Diabetes Causally Reduces Circulating Vitamin D Levels: A Multi-Ancestry Mendelian Randomization Study

Background: Vitamin D (25(OH)D) deficiency affects over one billion people globally and is associated with type 2 diabetes (T2D) and cardiometabolic diseases. However, causal relationships remain unclear, as vitamin D supplementation has shown limited benefit in reducing the risk of T2D. Genetic studies have identified variants that influence circulating 25(OH)D levels, but whether genetically determined vitamin D status predicts cardiometabolic outcomes remains uncertain. Methods and Results: Using multi-ethnic populations from the UK Biobank (471,861) and the Asian Indian Diabetic Heart Study (3486), we performed genome-wide univariate and polygenic risk score (PRS)-based bidirectional MR analyses to determine the causal association between vitamin D and T2D. A polygenic score of vitamin D-raising alleles did not affect the risk of T2D or cardiovascular disease. In contrast, a higher T2D PRS was strongly associated with an increased risk for 25(OH)D deficiency. Genetically instrumented per SD increase in T2D PRS was predicted to significantly (p = 9.5 × 10^-31) reduce circulating 25(OH)D (β = -9.1 nmol/L; 95% CI: -8.9 to -9.3). The ancestry-specific univariate MR and sensitivity analyses confirmed that vitamin D levels reduced significantly with increasing T2D risk across all ancestries. Conclusions: Our findings suggest low circulating vitamin D levels are unlikely to causally predict T2D risk but may serve as a marker for secondary prevention in endocrine and cardiovascular health. Instead, genetic susceptibility to T2D appears to contribute to vitamin D insufficiency, which may lead to cardiovascular complications. Further studies are needed to clarify the mechanisms underlying vitamin D deficiency in diabetes.