Department of Cardiovascular & Metabolic Medicine and the Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
Department of Diabetes, Endocrinology & Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Diabetes Metab Res Rev. 2021 Jan;37(1):e3361. doi: 10.1002/dmrr.3361. Epub 2020 Jul 9.
The aetiology of painful diabetic neuropathy is unclear. We have evaluated vitamin D levels in diabetic patients with and without painful neuropathy.
Forty-three patients with type 1 diabetes and painless (DPN) (n = 20) or painful (PDN) (n = 23) neuropathy and 14 non-diabetic healthy control subjects (C) underwent assessment of neurologic deficits, quantitative sensory testing (QST), electrophysiology, skin biopsy, corneal confocal microscopy (CCM) and measurement of serum 25(OH)D.
There were no significant differences for age, BMI, HbA , lipids, neurological deficits, QST, electrophysiology, intra-epidermal nerve fibre density (IENFD) and corneal nerve morphology between patients with DPN and PDN. Both positive (hyperalgesia and allodynia) and negative symptoms (paraesthesia and numbness) of diabetic neuropathy were greater in PDN compared with DPN (P = .009 and P = .02, respectively). Serum 25(OH)D levels were significantly lower in PDN (24.0 ± 14.1 ng/mL) compared with DPN (34.6 ± 15.0 ng/mL, P = .01) and controls (34.1 ± 8.6 ng/mL, P = .03). The odds ratio in favour of painful diabetic neuropathy was 9.8 [P = .003 (95% CI, 2.2-76.4)] for vitamin D deficiency (<20 ng/mL) and 4.4 [P = .03 (95% CI, 1.1-19.8)] for vitamin D insufficiency (<30 ng/mL).
This study suggests that vitamin D deficiency and insufficiency are associated with painful diabetic neuropathy.
痛性糖尿病周围神经病的病因尚不清楚。我们评估了有和无痛性糖尿病周围神经病（DPN）的糖尿病患者的维生素 D 水平。
43 例 1 型糖尿病患者，其中 20 例为无痛性（DPN）神经病变，23 例为痛性（PDN）神经病变，14 例非糖尿病健康对照者（C）接受了神经缺陷评估、定量感觉测试（QST）、电生理学、皮肤活检、角膜共聚焦显微镜（CCM）和血清 25（OH）D 测量。
DPN 和 PDN 患者的年龄、BMI、HbA1c、血脂、神经缺陷、QST、电生理学、表皮内神经纤维密度（IENFD）和角膜神经形态均无显著差异。与 DPN 相比，PDN 患者的糖尿病周围神经病阳性（痛觉过敏和感觉异常）和阴性症状（感觉异常和麻木）更为明显（P =.009 和 P =.02）。PDN 患者的血清 25（OH）D 水平明显低于 DPN（24.0±14.1 ng/mL）和对照组（34.1±8.6 ng/mL，P =.03）。维生素 D 缺乏（<20ng/mL）有利于痛性糖尿病周围神经病的优势比为 9.8[P =.003（95%CI，2.2-76.4）]，维生素 D 不足（<30ng/mL）为 4.4[P =.03（95%CI，1.1-19.8）]。
本研究表明，维生素 D 缺乏和不足与痛性糖尿病周围神经病有关。
