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Patients with Diabetic Peripheral Neuropathy Found to Have Low Vitamin D

Individuals with chronic pain and diabetes should be screened for vitamin levels

A PPM Brief

Type 2 Diabetes patients with painful diabetic peripheral neuropathy were found1 to have significantly lower vitamin D levels compared with healthy volunteers and patients with Type 2 Diabetes without neuropathy or with painless neuropathy. Researchers evaluated data from 59 individuals (14 healthy volunteers, 14 with Type 2 Diabetes patients without neuropathy, 14 patients with Type 2 Diabetes and painless diabetic peripheral neuropathy, and 17 with Type 2 Diabetes and painful diabetic peripheral neuropathy) from the Sheffield Teaching Hospitals NHS Foundation Trust diabetes database and outpatient clinics from 2013 to 2014.

“There is some evidence, although not consistent, that vitamin D supplementation improves painful neuropathic symptoms,” researchers wrote. “Our study was designed to address these limitations.”

Patients with diabetic peripheral neuropathy had higher BMI (P = .02) and were older (P = .009) than the healthy volunteers and patients without neuropathy. Patients with neuropathy had significantly higher scores on the Neuropathy Impairment Score Lower Limb and very low intra-epidermal nerve fiber density (P < .01). Researchers adjusted for age, BMI, activity score and sunlight exposure and found significantly lower 25-hydroxyvitamin D levels in patients with painful diabetic peripheral neuropathy; researchers found no significant differences between groups in estimates of sunlight exposure or outdoor activity.1

Individuals with chronic pain and diabetes should be screened for vitamin levelsIndividuals with chronic pain and diabetes should be screened for vitamin levels. (Source: 123RF)

Researchers also conducted a direct logistic regression analysis to assess the impact of age, BMI, sunlight exposure score, activity score, diabetes duration, mean arterial blood pressure and vitamin D levels on painful diabetic peripheral neuropathy. The analysis revealed that vitamin D was the only independent variable that statistically significantly contributed to the model (inverted OR = 1.11). Data also revealed a significant negative correlation between vitamin D levels and pain scores (P = .02), but no significant correlation between vitamin D levels and nerve conduction studies. Lower 25-hydroxyvitamin D levels were also associated with lower cold detection thresholds (P = .02) and subepidermal nerve fiber densities (P = .01).1

Researchers also evaluated the relationship between vitamin D levels and HbA1c and found a significant negative correlation with higher glucose load associated with lower vitamin D levels (P = .01). “This suggests a possible role for vitamin D in the pathogenesis of painful diabetic peripheral neuropathy,” the researchers wrote. “Further prospective and intervention trials are required to prove causality between low vitamin D levels and painful diabetic peripheral neuropathy.”

Last updated on: September 28, 2018
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