Vitamin D Supplementation and Microcirculation Parameters in Diabetic Patients with Neuropathy

Abstract

Type 2 diabetes mellitus (T2DM) is often combined with vitamin D (VD) deficiency. It is known that VD affects glycemic control as well as systemic inflammation and could play a role in diabetic neuropathy (DN) pathogenesis. High VD dose supplementation decreases impaired microcirculation in diabetic patients and reduces DN severity. NTSS-9, NDS scales were used, 25(OH)D, HbA1c were studied in 24 (12F) patients with T2DM and DN. Parameters of microcirculation (value of perfusion - M, standard deviation - σ, Kv - coefficient of microcirculation) by laser Doppler fluorometry (LAKK-M, Russia) baseline and after 24 weeks of VD supplementation. Inclusion criteria: T2DM duration more then 5 years, HbA1c ≤9.0%, NDS index 4 and more, signed IC. Patients were randomized in to two groups: 5000 IU (group I) and 40000 IU (group II) per week cholecalciferol treatment without hypoglycemic treatment changes. At baseline the two groups were comparable by sex, age, BMI, HbA1c level. We included in group I twelve pts (6F) aged 56,1±5,4 with mean HbA1c 8.2±0.4% and 25(OH)D level 21.4±3.4 nmol/l. In group II we included 12 pts (6F), mean age 51,3±5,9, HbA1c 8.4±0.6%, 25(OH)D 20.9±4,1 nmol/l. Baseline NDS index did not differ between the two groups 10.1±3.3 and 12.3± 4.7 accordingly, as well as the NTSS-9 index 15.8±5.2 and 17.1±6.8 (p>0.05). Parameters of microcirculation were the same M=10.63±1.37 and 12.36±2.51 BPU, σ=5.32±0.79 and 4.44±1.05, Kv=11.36±1.59 and 10.64±2.93. After 24 weeks of VD treatment we did not find changes in group I - HbA1c 8.1±0.4%, 25(OH)D 24,7±2.5 (p=0,07), M=10.30±1.14 (p=0.08), σ=4.98±0.56 (p=0.05) and Kv=11.82±2.38 (p=0.87). HbA1c significantly decreased till 7.4±0.7% (p=0.023) in group II. 25(OH)D level increased to 60,9±3.1 (p=0,003). We found improvement of all microcirculation parameters M=19.69±2.52 (p=0.003), σ=6.05±0.93 (p=0.005), Kv=13.36±3.15 (p=0.017) compared to baseline. High dose of VD supplementation could improve microcirculation parameters in T2DM patients with DN. Disclosure A.P. Stepanova: None. T.L. Karonova: None. E.B. Jude: Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Novo Nordisk A/S, Takeda Development Centre Europe Ltd., Bayer AG, Boehringer Ingelheim GmbH, Eli Lilly and Company.

Role of vitamin D deficiency in type 2 diabetes mellitus and diabetic neuropathy development

“…В другой работе было отмечено значительное снижение симптомов болевой ДПН у пациентов с СД2 через 20 нед после однократного внутримышечного введения 600 000 МЕ витамина D [49]. В проведенном нами исследовании добавка витамина D в дозе 40000 МЕ в неделю в течение 6 мес значимо снизила уровень HbA 1c у больных СД2 и ДН [50].…”