ALB and nutritional deficiency disease: Lower albumin has been associated with DKD [10] and frailty in older people with type 2 diabetes [39] and albumin levels are inversely associated with CVD or mortality in people with CKD [40], suggesting that as a marker linked with malnutrition, liver and kidney dysfunction and inflammation, albumin may partly capture the integrated altered metabolic signature in diabetes and thus associates with adverse outcomes.