The Benefits of Add-on Therapy of Vitamin D 5000 IU to the Vitamin D Levels and Symptoms in Diabetic Neuropathy Patients: A Randomized Clinical Trial

Rizaldy Taslim Pinzon, Vincent Ongko Wijaya, Vanessa Veronica, Rizaldy Taslim Pinzon, Vincent Ongko Wijaya, Vanessa Veronica

Abstract

Background: Previous studies have demonstrated a significant relationship between vitamin D deficiency and the development of diabetic peripheral neuropathy (DPN). However, current studies are limited regarding the potential therapeutic benefits of vitamin D therapy in these patients.

Objective: This study aimed to assess the effect of oral vitamin D supplementation in patients with diabetic peripheral neuropathy in addition to standard treatment.

Methods: This study was a controlled, open-label, randomized clinical trial with an active comparator randomly allocated with a 1:1 ratio. The experimental group received an add-on oral vitamin D 5000 IU once daily and standard treatment (pregabalin, gabapentin, or amitriptyline) over eight weeks. The control group received standard treatment alone. The measured outcomes were the change in the score of the visual analog scale (VAS), numerical rating scale (NRS), and brief pain inventory (BPI). Vitamin D levels were also measured before and after the trial.

Results: Data from 68 subjects with DPN was collected and analyzed. Most of them (60.3%) were female, aged 64.96 ± 8.3 years. After eight weeks of treatment, the experimental group showed a more significant reduction of mean VAS (-3.34 ± 2.03 vs -2.37 ± 2.2, p=0.044) and burning pain (1.76 ± 7.16 vs 6.18 ± 13.93, p=0.046) scores compared to controls. Mood also improves better in the experimental group (88.2% vs 70.6%, p=0.031). At the end of the study, vitamin D levels were also improved more significantly in the experimental group (40.02 ± 15.33 ng/mL vs 18.73 ± 6.88 ng/mL; p<0.001) with greater changes from the baseline to week 8 (+24.14±13.68 ng/mL vs +3.10±4.20 ng/mL; p<0.001) compared to control group. The intervention group showed a negative correlation between vitamin D level and VAS score (r = -0.403, P = 0.018). There were no adverse events recorded in this study.

Conclusion: The addition of oral vitamin D 5000 IU to standard treatment significantly improves pain, mood, and vitamin D levels more effectively than standard treatment alone in patients with diabetic neuropathy.

Trial registration: ClinicalTrials.gov.no NCT04689958.

Keywords: diabetes; diabetic neuropathy; supplementation; vitamin D.

Conflict of interest statement

The authors declare no conflicts of interest.

© 2021 Pinzon et al.

Figures

Figure 1
Figure 1
CONSORT flow chart of the study.
Figure 2
Figure 2
Correlation between vitamin D levels [serum 25(OH) D] and the VAS at week-8 in the experimental group.
Figure 3
Figure 3
Correlation between vitamin D levels [serum 25(OH) D] and the VAS at week-8 in the control group.
Figure 4
Figure 4
Distribution of sleep quality, general activity, and mood improvement at week 8 in the experimental and control groups.
Figure 5
Figure 5
Change from baseline in mean vitamin D levels [serum 25(OH) D], before and after the intervention between both groups (in ng/mL).

References

    1. Ghadiri-Anari A, Mozafari Z, Gholami S, et al. Does vitamin D supplementations improve peripheral diabetic neuropathy? A before-after clinical trial. Diabetes Metab Syndr. 2019;13(1):890–893. doi:10.1016/j.dsx.2018.12.014
    1. Shehab D, Al-Jarallah K, Abdella N, Mojiminiyi OA, Al Mohamedy H. Prospective evaluation of the effect of short-term oral vitamin D supplementation on peripheral neuropathy in type 2 diabetes mellitus. Med Princ Pract. 2015;24(3):250–256. doi:10.1159/000375304
    1. Chaychi L, Mackenzie T, Bilotta D, Lynch M, Cohen J, Comi R. Association of serum vitamin D level with diabetic polyneuropathy. Med Practise Rev Feb. 2011;2:11–15.
    1. 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(1):43–49. doi:10.1111/j.1464-5491.2011.03510.x
    1. Soderstrom LH, Johnson SP, Diaz VA, Mainous AG. Association between vitamin D and diabetic neuropathy in a nationally representative sample: results from 2001–2004 NHANES. Diabet Med. 2012;29(1):50–55. doi:10.1111/j.1464-5491.2011.03379.x
    1. Valensi P, Le Devehat C, Richard JL, et al. A multicenter, double-blind, safety study of QR-333 for the treatment of symptomatic diabetic peripheral neuropathy. A preliminary report. J Diabetes Complications. 2005;19(5):247–253. doi:10.1016/j.jdiacomp.2005.05.011
    1. Lee P, Chen R. Vitamin D as an analgesic for patients with type 2 diabetes and neuropathic pain. Arch Intern Med. 2008;168(7):771–772. doi:10.1001/archinte.168.7.771
    1. Bell DS. 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. doi:10.1155/2012/165056
    1. Sadosky A, Schaefer C, Mann R, et al. Burden of illness associated with painful diabetic peripheral neuropathy among adults seeking treatment in the US: results from a retrospective chart review and cross-sectional survey. Diabetes Metab Syndr Obes. 2013;6:79–92. doi:10.2147/DMSO.S37415
    1. Basit A, Basit KA, Fawwad A, et al. Vitamin D for the treatment of painful diabetic neuropathy. BMJ Open Diabetes Res Care. 2016;4(1):e000148. doi:10.1136/bmjdrc-2015-000148
    1. Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Res Rev. 1999;15(3):205–218. doi:10.1002/(SICI)1520-7560(199905/06)15:3<205::AID-DMRR29>;2-O
    1. Alam U, Fawwad A, Shaheen F, et al. Improvement in neuropathy specific quality of life in patients with diabetes after vitamin d supplementation. J Diabetes Res. 2017:7928083. doi:10.1155/2017/7928083
    1. Forouhi NG, Ye Z, Rickard AP, et al. Circulating 25-hydroxyvitamin D concentration and the risk of type 2 diabetes: results from the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort and updated meta-analysis of prospective studies. Diabetologia. 2012;55(8):2173–2182. doi:10.1007/s00125-012-2544-y
    1. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008;87(4):1080S–1086S. doi:10.1093/ajcn/87.4.1080S
    1. Tague SE, Smith PG. Vitamin D receptor and enzyme expression in dorsal root ganglia of adult female rats: modulation by ovarian hormones. J Chem Neuroanat. 2011;41(1):1–12. doi:10.1016/j.jchemneu.2010.10.001
    1. Tague SE, Clarke GL, Winter MK, McCarson KE, Wright DE, Smith PG. Vitamin D deficiency promotes skeletal muscle hypersensitivity and sensory hyperinnervation. J Neurosci. 2011;31(39):13728–13738.
    1. Carlson AN, Kenny AM. Is vitamin D insufficiency associated with peripheral neuropathy? Endocrinologist. 2007;17:319–325. doi:10.1097/TEN.0b013e3181594284
    1. Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab. 2007;92(6):2017–2029. doi:10.1210/jc.2007-0298
    1. Dalgard C, Petersen MS, Weihe P, et al. Vitamin D status in relation to glucose metabolism and type 2 diabetes in septuagenarians. Diabetes Care. 2011;34:1284–1288. doi:10.2337/dc10-2084
    1. Maddaloni E, Cavallari I, Napoli N, Conte C. Vitamin D and diabetes mellitus. Vitamin D in clinical medicine. Front Horm Res. 2018;50:161–176. doi:10.1159/000486083
    1. Lips P, Eekhoff M, van Schoor N, et al. Vitamin D and type 2 diabetes. J Steroid Biochem Mol Biol. 2017;173:280–285. doi:10.1016/j.jsbmb.2016.11.021

Source: PubMed

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