Skip to main content
The Egyptian Journal of Internal Medicine
Download PDF
  • Original article
  • Open access
  • Published:

Effect of vitamin D replacement on cardiometabolic risk factors and electrophysiological pattern of peripheral neuropathy in vitamin D-insufficient or deficient type 2 diabetic patients

The Egyptian Journal of Internal Medicine volume 31, pages 669–677 (2019)Cite this article

Abstract

Background

Diabetic neuropathy is one of the commonest chronic complications of diabetes seen in routine healthcare and considered the most common cause of peripheral neuropathy all over the world. Vitamin D (VD) deficiency is now recognized as a pandemic disease. This study was designed to explore the levels of 25-hydroxycholecalciferol [25(OH) D] in patients with type 2 diabetes mellitus (T2DM) with peripheral neuropathy. We also aimed to clarify the effect of VD supplementation on cardiometabolic status and electrophysiological pattern of peripheral neuropathy.

Patients and methods

This clinical trial enrolled 95 patients with T2DM with peripheral neuropathy. The enrolled patients were divided into three groups according to serum 25(OH) D levels. VD deficiency and insufficiency groups received VD supplements (42,000 IU oral VD per week and 500-mg calcium carbonate per day for 12 weeks). Clinical, electrophysiological pattern, and laboratory parameters were evaluated at baseline and after 12 weeks of intervention. Serum 25(OH) D levels were measured by using a competitive enzyme-linked immunosorbent assay kit.

Results

Our results revealed that, among 95 patients with T2DM with peripheral neuropathy, 32 patients had VD insufficiency [20 ng/ml <25(OH) D <30 ng/ml], 50 patients had VD deficiency [25(OH) D < 20 ng/ml], and 13 patients had VD sufficiency [25(OH) D >30 ng/ml]. Our results reported that 25(OH) D levels were negatively correlated with cardiometabolic risk factors and Toronto Clinical Scoring System. On the contrary, 25(OH) D levels were positively correlated with nerve conduction velocities (NCV). Stepwise multiple linear regression analysis revealed that glycated hemoglobin and Toronto Clinical Scoring System were the main predictors of 25(OH) D levels among other clinical and laboratory biomarkers. Logistic regression analysis observed that motor NCV and sensory NCV of median nerve and glycated hemoglobin were independent predictors of response to VD supplementation. NCV in studied groups showed that motor NCV and sensory NCV in the median, posterior tibial, and ulnar nerves were significantly decreased in both VD deficiency and insufficiency groups compared with VD sufficiency groups, and supplementation with 42 000 IU oral VD per week and 500-mg calcium carbonate per day for 12 weeks improved cardiometabolic risk factors and electrophysiological pattern of peripheral neuropathy.

Conclusion

The supplementation of VD for 12 weeks to VD deficiency and insufficiency groups improved the cardiometabolic and electrophysiological pattern of peripheral neuropathy.

References

  1. Lv WS, Zhao WJ, Gong SL, Fang DD, Wang B, Fu ZJ, et al. Serum 25-hydroxyvitamin D levels and peripheral neuropathy in patients with type 2 diabetes: a systematic review and meta-analysis. J Endocrinol Invest 2015; 38:513–518.

    Article  CAS  Google Scholar 

  2. Boulton AJM, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freem R, et al. Diabetic neuropathies. Diabetes Care 2005; 28:956–962.

    Article  Google Scholar 

  3. Holick MF. Vitamin D. the underappreciated D-lightful hormone that is important for skeletal and cellular health. Curr Opin Endocrinol Diabetes 2002; 9:87–98.

    CAS  Google Scholar 

  4. Hilger J, Friedel A, Herr R, Rausch T. A systematic review of vitamin D status in populations worldwide. Br J Nutr 2014; 111:23–45.

    Article  CAS  Google Scholar 

  5. Reis AF, Hauache OM, Velho G. Vitamin D endocrine system and the genetic susceptibility to diabetes, obesity and vascular disease. A review of evidence. Diabetes Metab 2005; 31(4 Part 1):318–325.

    Article  CAS  Google Scholar 

  6. Knekt P, Laaksonen M, Mattila C, Harkanen T, Marniemi J, Heliovaara M, et al. Serum vitamin D and subsequent occurrence of type 2 diabetes. Epidemiology 2008; 19:666–671.

    Article  Google Scholar 

  7. Bell DSH. Reversal of the symptoms of diabetic neuropathy through correction of vitamin D deficiency in a type 1 diabetic patient. Case Rep Endocrinol 2012; 2012:165056.

    PubMed  PubMed Central  Google Scholar 

  8. Shehab D, Al-Jarallah K, Mojiminiyi OA, Al Mohamedy H, Abdella NA. Does vitamin D deficiency play a role in peripheral neuropathy in type 2 diabetes? Diabet Med 2012; 29:43–49.

    Article  CAS  Google Scholar 

  9. Daga RA, Laway BA, Shah ZA, Mir SA, Kotwal SK, Zargar AH. High prevalence of vitamin D deficiency among newly diagnosed youth-onset diabetes mellitus in north India. Arq Bras Endocrinol Metabol 2012; 56:423–428.

    Article  Google Scholar 

  10. Meijer WG, Bosma E, Lefrandt JD, Links TP, Smit AJ, Van Der Hoeven JH, Hoogenberg K. Clinical diagnosis of diabetic polyneuropathy with the diabetic neuropathy symptom and diabetic neuropathy examination scores. Diabetes Care 2003; 26:697–701.

    Article  Google Scholar 

  11. Sachedina S, Toth C. Association of comorbidities with increasing severity of peripheral neuropathy in diabetes mellitus. World J Diabetes 2013; 4:135–144.

    Article  Google Scholar 

  12. Dyck PJ, Carter RE, Litchy WJ. Modeling nerve conduction criteria for diagnosis of diabetic polyneuropathy. Muscle Nerve 2011; 44:340–345.

    Article  Google Scholar 

  13. Alamdari A, Mozafari R, Tafakhori A, Faghihi-Kashani S, Hafezi-Nejad N, Sheikhbahaei S, et al. An inverse association between serum vitamin D levels with the presence and severity of impaired nerve conduction velocity and large fiber peripheral neuropathy in diabetic subjects. Neurol Sci 2015; 36:1121–1126.

    Article  Google Scholar 

  14. Bos M, Agyemang C. Prevalence and complications of diabetes mellitus in Northern Africa, a systematic review. BMC Public Health 2013; 13:387.

    Article  Google Scholar 

  15. El Badawy AA, GFE S, Fahmy HH, Demitry SR, Sherif NA, Badawy SAE. Vitamin D status and some related factors among a sample of females living in rural area of Sharkia Governorate. Cairo: Egypt Osteoporosis Prevention Society Conference; 2009.

  16. Raman R, Gupta A, Krishna S, Kulothungan V, Sharma T. Prevalence and risk factors for diabetic microvascular complications in newly diagnosed type II diabetes mellitus. SankaraNethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, report 27). J Diabetes Complications 2012; 26:123–128.

    Google Scholar 

  17. Riaz S, Malcangio M, Miller M, Tomlinson DR. A vitamin D (3) derivative (CB1093) induces nerve growth factor and prevents neurotrophic deficits in streptozotocin-diabetic rats. Diabetologia 1999; 42:1308–1313.

    Article  CAS  Google Scholar 

  18. Abdelsadek SE, El Saghier EO, Abdel Raheem SI. Serum 25(OH) vitamin D level and its relation to diabetic peripheral neuropathy in Egyptian patients with type 2 diabetes mellitus. Egypt J Neurol Psychiatry Neurosurg 2018; 54:36.

    Article  Google Scholar 

  19. Celikbilek A, Gocmen AY, Tanik N, Borekci E, Adam M, Celikbilek M. Decreased serum vitamin D levels are associated with diabetic peripheral neuropathy in a rural area of Turkey. Acta Neurol Belg 2015; 115:47–52.

    Article  Google Scholar 

  20. Kheyami A. Vitamin D and diabetic neuropathy [thesis]. Submitted to the University of Manchester for the degree of MPhil in the Faculty of Medical and Human Sciences, 2014. p. 227782.

  21. Putz Z, Martos T, Németh N, Körei AE, Szabó M, Vági O, et al. Vitamin D and neuropathy. Orv Hetil 2013; 154:2012–2015.

    Article  Google Scholar 

  22. Zhang FF, Al Hooti S, Al Zenki S, Alomirah H, Jamil KM, Rao A, et al. Vitamin D deficiency is associated with high prevalence of diabetes in Kuwaiti adults: results from a national survey. BMC Public Health 2015; 16:100.

    Article  Google Scholar 

  23. Bland R, Markovic D, Hills CE, Hughes SV, Chan SL, Squires PE, et al. Expression of 25-hydroxyvitamin D3-1alpha-hydroxylase in pancreatic islets. J Steroid Biochem Mol Biol 2004; 89–90:121–125.

    Article  Google Scholar 

  24. Milner RD, Hales CN. The role of calcium and magnesium in insulin secretion from rabbit pancreas studied in vitro. Diabetologia 1967; 3:47–49.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt

    Nearmeen M. Rashad MD & Ahmed F. Gomaa

  2. Department of Neurology, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Hanan M. Sabry

  3. Department of Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Amany M. Ebaid

  4. Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Hala G. Abomandour

  5. Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Reem M. Allam

Authors
  1. Nearmeen M. Rashad MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hanan M. Sabry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed F. Gomaa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amany M. Ebaid
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hala G. Abomandour
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Reem M. Allam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nearmeen M. Rashad MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rashad, N.M., Sabry, H.M., Gomaa, A.F. et al. Effect of vitamin D replacement on cardiometabolic risk factors and electrophysiological pattern of peripheral neuropathy in vitamin D-insufficient or deficient type 2 diabetic patients. Egypt J Intern Med 31, 669–677 (2019). https://doi.org/10.4103/ejim.ejim_62_19

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejim.ejim_62_19

Keywords