Vitamin D Status and Neuropathic Pain Phenotypes in Diabetic Peripheral Neuropathy
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Background: Diabetic peripheral neuropathy is a common complication of type 2 diabetes mellitus and presents with heterogeneous painful and sensory phenotypes. Vitamin D deficiency is frequent in diabetic populations, but its relationship with specific neuropathic pain patterns remains insufficiently characterized. Objective: To evaluate the association between serum 25-hydroxyvitamin D status and neuropathic pain phenotypes, pain severity, and sensory findings among adults with type 2 diabetes mellitus and diabetic peripheral neuropathy. Methods: This hospital-based analytical cross-sectional study included 180 adults with type 2 diabetes mellitus and clinical diabetic peripheral neuropathy. Participants were classified as vitamin D deficient, insufficient, or sufficient according to serum 25-hydroxyvitamin D levels. Neuropathic pain was assessed using DN4, visual analogue scale, Neuropathic Pain Symptom Inventory, clinical sensory examination, and modified Toronto Clinical Neuropathy Score. Results: Vitamin D deficiency was present in 104 participants, insufficiency in 49, and sufficiency in 27. DN4-defined painful neuropathy was more frequent in deficient participants than sufficient participants. The deficient group had higher VAS score, NPSI score, modified TCNS score, abnormal monofilament findings, and reduced vibration sense. Vitamin D deficiency remained associated with painful diabetic neuropathy after adjustment for age, sex, diabetes duration, and HbA1c. Conclusion: Vitamin D deficiency was associated with greater painful neuropathy burden and more frequent sensory abnormalities in diabetic peripheral neuropathy. Vitamin D assessment may be a useful supportive component of phenotype-based neuropathy evaluation
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