Abstract
Clonal haematopoiesis of indeterminate potential (CHIP) and low vitamin D are recognised as independent risk factors for type 2 diabetes mellitus (T2DM); however, their joint effects on T2DM incidence remain unclear. We hypothesised that CHIP mutations and vitamin D deficiency may be jointly associated with the risk of T2DM. This study included 405,095 participants from the UK Biobank without T2DM at baseline. CHIP was identified through whole-exome sequencing of peripheral blood samples, and vitamin D was categorised into quartiles. All the participants' variables were tested at baseline. Cox regression was used to evaluate the joint effects of CHIP and vitamin D on incident T2DM. The mean age of the participants was 56.4 ± 8.1 years, and 54.0% were female. After a median follow-up of 12.9 years, 24,724 (6.1%) participants developed T2DM. Multivariable analyses revealed that higher vitamin D quartiles were associated with a lower risk of incident T2DM (HR [95% CI]: 0.89 [0.86-0.92], 0.78 [0.75-0.81], and 0.70 [0.67-0.73] for the 2nd, 3rd, and 4th quartiles vs. Q1, respectively), with similar associations observed in participants with and without CHIP, and no evidence of interaction. In contrast, the presence of CHIP was not clearly associated with incident T2DM after adjustment (HR 1.03 [0.97-1.09]). These findings suggest that vitamin D is associated with type 2 diabetes risk, independent of clonal haematopoiesis, and may help to contextualise risk heterogeneity among individuals with and without CHIP.</p>