Effect of Vitamin D in Patients With Diabetic Peripheral Neuropathy to Alleviate Pain and Improvement of Symptoms

March 7, 2022 updated by: Dr. Zannatul Ferdous, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Randomized, Double-Blind, Placebo-Controlled Study to Assess the Effect of Vitamin D in Patients With Diabetic Peripheral Neuropathy to Alleviate Pain and Improvement of Symptoms

Diabetic peripheral neuropathy(DPN) is one of the major complications of diabetes mellitus which accelerates the occurrence of ulceration of diabetic foot and amputation of lower extremities as well as severely affects the quality of life. The treatment of this condition has remained unsatisfactory with a good response to conventional medications. It is now evident that vitamin D deficiency is common in diabetic patients and especially in these patients diagnosed with diabetic peripheral neuropathy. The present research is therefore designed to observe the effect of exogenous administration of vitamin D in diabetic peripheral neuropathy patients of Bangladesh.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Diabetic peripheral neuropathy is one of the common complications of long-standing diabetes mellitus with a prevalence of 30% to 50%. It accelerates the occurrence of ulcers of diabetic foot and amputation of lower extremities as well as severely affects the quality of life. The treatment of this condition has remained unsatisfactory in spite of a good response to conventional medications. Studies showed that Vitamin D3 exerts a neuroprotective effect through the production of nerve growth factor (NGF) and neurotrophins. However, some recent trials demonstrated that vitamin D3 could be a promising agent in this regard. This proposed study was therefore an effort whether there is any role of vitamin D3 in improving symptoms of diabetic peripheral neuropathy patients. This study was a randomized, double-blind, placebo-controlled trial, conducted in the Department of Pharmacology in collaboration with the Department of Endocrinology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from September 2019 to January 2022. A total of 72 patients suffering from diabetic peripheral neuropathy was enrolled according to inclusion and exclusion criteria. A validated version of the Michigan Neuropathy Screening Instrument (MNSI) and Visual Analogue Scale (VAS) was used to assess peripheral neuropathy. Then the patients were randomly allocated into two arms: control and intervention. The patient in the control arm received the standard antidiabetic medications plus one placebo capsule weekly orally for 8 weeks starting from the day of an initial assessment. On the other hand, the intervention arm received the standard antidiabetic medications plus one capsule of vitamin D3 (40,000 IU) weekly orally for 8 weeks starting from the day of an initial assessment. Data of HbA1c level was recorded and a blood sample was collected to measure serum 25(OH) D level at baseline and after 8 weeks of therapeutic intervention. Confirmation of the regular intake of medicine was ensured over the telephone, pill count, and from the patient's compliance sheet. After 8 weeks each patient was evaluated again using VAS and MNSI tools. Out of 72, 53 patients had completed the study and met the criteria for analysis. Therefore, Intention to Treat (ITT) was 72 and Per Protocol (PP) treatment was 53. The statistical tests used to analyze the data were the chi-square (x2) test, paired t-test, unpaired t-test, and Pearson correlation test. The chi-square (x2) test was used to compare categorical data between two groups. The independent t-test was used to compare the continuous data between two groups. P-value ≤ 0.05 was considered significant. After 8 weeks of treatment, the VAS score of pain in DPN patients in the intervention arm reduced significantly (P=0.00) from 5.50 ± 0.64 to 4.23 ± 0.98. In the intervention arm, statistically significant improvement was also observed in the MNSI score both for the questionnaire (from 8.54 ± 1.15 to 6.00 ± 1.32; P=0.00) and physical assessment (from 3.44 ± 1.22 to 2.40 ± 1.06; P=0.00) respectively. Serum 25(OH)D level significantly improved (P=0.00) after oral administration of vitamin D3 in the intervention arm from 10.83 ± 4.47 ng/ml to 17.79 ± 7.53 ng/ml. The reduction observed in HbA1c level in the intervention arm (from 8.66 ± 1.39 to 7.25 ± 0.87) was significant (P=0.00). This should be noted that a significant reduction of VAS score (P= 0.04) and MNSI questionnaire score (P=0.00) was observed in the placebo arm after 8 weeks, though the difference between the reduction achieved was significant between placebo and intervention arm (for VAS, P=0.00 and for MNSI, P=0.00). However, in the control arm, there was no significant reduction (P=0.69) in MNSI physical assessment score. A negative correlation was observed between serum 25(OH) D level and VAS (r= -0.1) and MNSI score (r= -0.17) respectively. Oral administration of 40,000 IU vitamin D3 weekly for 8 weeks along with standard antidiabetic medications produces a significant reduction of the level of pain and other neuropathic symptoms in the patients with Diabetic Peripheral Neuropathy.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
72

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Bangladesh
      • Dhaka, Bangladesh, 1000
        • Department of Pharmacology, BSMMU

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

30 years to 70 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Confirmed diagnosis of Type II Diabetes Mellitus patients who have been on anti-diabetic therapy for 1 year or more
  • Diabetic patient who meet the clinical criteria for DPN diagnosed by an endocrinologist of OPD of endocrinology
  • Age between 30 and 70 years
  • Gender: Both Male and Female
  • Patients who will give informed written consent

Exclusion Criteria:

  • Patients suffering from other causes of peripheral neuropathy for example chemotherapy-induced neuropathy, hyperthyroidism or hypothyroidism, rheumatoid arthritis, SLE
  • Pregnant or lactating women
  • Patients with renal and liver disease, psychiatric disorder
  • Patients receiving vitamin D, vitamin B6, vitamin B12 supplementation, anticonvulsants, antidepressants, opioids, and other neuropathic pain medications within the last two months.
  • Serum calcium level: > 10.2 mg/dl
  • HbA1c level > 11%

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Active Comparator: Experimental
This arm includes 36 Diabetic Peripheral Neuropathy patients receiving the antidiabetic medications
Dietary supplement: Vitamin D3

Dietary supplement:Vitamin D3

1 capsule of Vitamin D3 (40,000IU) weekly for 8 weeks with antidiabetic drug

Other Names:
  • Cholecalciferol
Placebo Comparator: Control
This arm includes 36 Diabetic Peripheral Neuropathy patients receiving the antidiabetic medications
Dietary supplement: Placebo
1 capsule weekly for 8 weeks with antidiabetic drug

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Change from baseline Visual Analogue Scale(VAS) score at 8 weeks.
Time Frame: 8 weeks
Assessment of severity of pain by using Visual Analogue Scale(VAS) at baseline and after 8 weeks and compare the score between two groups. VAS is a 0-10 numeric pain scale scored by No pain (score 0-3), moderate pain (scoring 4-6), and unbearable pain (score 7-10).
8 weeks
Change from baseline Michigan Neuropathy Screening Instrument (MNSI) scores at 8 weeks.
Time Frame: 8 weeks
Assessment of severity of neuropathic symptoms by using MNSI score at baseline and after 8 weeks and comparing the score between two groups. MNSI is composed of 15 items questionnaire and a brief clinical examination. MNSI questionnaire score of 7 or more indicates the presence of diabetic peripheral neuropathy. 13 is the highest score indicating the worst disease. Whereas, MNSI Physical assessment score of 2.5 or more indicates the presence of diabetic peripheral neuropathy.
8 weeks

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Change from baseline Serum 25(OH) D level at 8 weeks.
Time Frame: 8 weeks
Serum 25(OH) D level is assessed at baseline and 8 weeks following vitamin D administration. Compare the serum 25(OH) D level between two groups.
8 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Zannatul Ferdous, MBBS, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • Study Chair: Prof. Md. Sayedur Rahman, MBBS, M Phil, FCPS, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
November 7, 2020

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
January 31, 2022

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
January 31, 2022

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
May 30, 2021

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 24, 2021

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
July 30, 2021

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
March 21, 2022

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
March 7, 2022

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
March 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • BSMMU/2020/9630

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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