In the MVMR analysis controlling for DBP, robust evidence was also demonstrated for a direct causal effect of ALT (IVW OR = 1.920, 95% CI = 1.630–2.211, p < 0.001) and AST (IVW OR = 1.605, 95% CI = 1.237–1.973, p = 0.012) on the risk of T2DM with DR (Fig 3A and 3B). The gene discussed is GPT; the disease is type 2 diabetes mellitus.