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      Does Vitamin D Affect Diabetic Neuropathic Pain and Balance?

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          Abstract

          Purpose

          This randomized, placebo-controlled study examined the effect of vitamin D replacement therapy on neuropathic symptoms and balance in patients with diabetic neuropathic pain and low vitamin D levels.

          Patients and Methods

          Among the 258 patients, the results in a total of 57 volunteers (32 in the treatment and 25 in the control arm) meeting the inclusion criteria are reported. Symptoms of neuropathic pain were assessed using Douleur Neuropathique 4 (DN4) questionnaire, and presence of polyneuropathy (PNP) was determined by performing electromyography (EMG). Balance was assessed using Berg balance test (BBT). After undergoing these examinations, the patients in the treatment group were intramuscularly (IM) injected with 300,000 IU vitamin D in a liquid formulation and those in the placebo group were IM injected with physiological saline. The DN4 and BBT were repeated after 12 weeks, and the results were compared.

          Results

          The patients in the treatment group showed a significant decrease in total DN4 scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.008). The patients in the treatment group also showed a significant increase in BBT scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.001). Furthermore, in subgroup analysis, these patients showed a significant decrease in electric shock and burning sensation scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.006, p=0.001, respectively).

          Conclusion

          In patients with diabetic neuropathic pain, vitamin D levels should be measured and vitamin D replacement therapy should be administered as required to resolve neuropathic symptoms and to improve balance.

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          Most cited references 22

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          Diabetic neuropathy: mechanisms to management.

          Neuropathy is the most common and debilitating complication of diabetes and results in pain, decreased motility, and amputation. Diabetic neuropathy encompasses a variety of forms whose impact ranges from discomfort to death. Hyperglycemia induces oxidative stress in diabetic neurons and results in activation of multiple biochemical pathways. These activated pathways are a major source of damage and are potential therapeutic targets in diabetic neuropathy. Though therapies are available to alleviate the symptoms of diabetic neuropathy, few options are available to eliminate the root causes. The immense physical, psychological, and economic cost of diabetic neuropathy underscore the need for causally targeted therapies. This review covers the pathology, epidemiology, biochemical pathways, and prevention of diabetic neuropathy, as well as discusses current symptomatic and causal therapies and novel approaches to identify therapeutic targets.
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            Serum 25-Hydroxy Vitamin D and Insulin Resistance, Metabolic Syndrome, and Glucose Intolerance Among Arab Americans

            OBJECTIVE To describe 25-hydroxy vitamin D (25-OH-D) levels and examine associations between 25-OH-D levels and insulin resistance (IR), metabolic syndrome (MS), and glucose intolerance in Arab Americans. RESEARCH DESIGN AND METHODS Serum 25-OH-D levels were measured in a representative, cross-sectional sample of 542 Arab Americans with IR (46%), MS (33%), and glucose intolerance (42%). RESULTS Vitamin D insufficiency (5 to <20 ng/ml) was present in 75% and hypovitaminosis D (20 to <40 ng/ml) in 24% of participants. In men, 25-OH-D levels were lower in those with glucose intolerance than normoglycemia (P = 0.01). No such difference was found in women. In men, 25-OH-D was negatively correlated with homeostasis model assessment of insulin resistance (r = −0.19; P = 0.0043), triglycerides (r = −0.18; P = 0.0069), fasting plasma glucose (r = −0.15; P = 0.027), and A1C (r = −0.14; P = 0.038). In women, 25-OH-D was positively correlated with HDL (r = 0.19; P = 0.0008). CONCLUSIONS Vitamin D insufficiency and hypovitaminosis D are extremely common among Arab Americans, and they are associated with IR, components of the MS, and glucose intolerance in men.
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              Vitamin D as an analgesic for patients with type 2 diabetes and neuropathic pain.

               Paul Lee,  Roger Chen (2008)
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                16 January 2020
                2020
                : 13
                : 171-179
                Affiliations
                [1 ]Department of Physical Medicine and Rehabilitation, Erenkoy Physical Medicine and Rehabilitation Hospital , Istanbul, Turkey
                [2 ]Department of Physical Medicine and Rehabilitation, Istinye University Medical Faculty , Istanbul, Turkey
                Author notes
                Correspondence: Aylin Sari Department of Physical Medicine and Rehabilitation, Erenkoy Physical Medicine and Rehabilitation Hospital , Semsettin Gunaltay Avenue Sultan Street No. 14, Kadikoy, Istanbul, TurkeyTel +905058396368Fax +902164783123 Email mdaylinsari@gmail.com
                Article
                203176
                10.2147/JPR.S203176
                6970609
                © 2020 Sari et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 3, Tables: 4, References: 31, Pages: 9
                Categories
                Original Research

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