In the MVMR analysis controlling for SBP, robust evidence was also demonstrated for a direct causal effect of ALT (IVW OR = 1.945, 95% CI = 1.668–2.223, p < 0.001) and AST (IVW OR = 1.669, 95% CI = 1.291–2.047, p = 0.008) on the risk of T2DM with DR (Fig 3A and 3B). This evidence concerns the gene GPT and type 2 diabetes mellitus.