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Vit. D
Micelle
formation
Vit. D in
chylomicron
Vit. D
Vit. D
Enterocyte
Golgi
apparatus
Vit. D
Hydrolysis
(pancreatic
lipase)
Vit. D
Golgi
Vit. D in
chylomicron apparatus
Interstitial fluid
Enterocyte
Interstitial fluid
D-RISE API
REFERENCES
1.
4.045
2.747
2.
Oil
Powder
4.
5.
6.
Supplement vehicle
8.
9.
Soderstrom LH, Johnson SP, Diaz VA, et al. Association between vitamin D
and diabetic neuropathy in a nationally representative sample: Results from
2001-2004 NHANES. Diabet Med. 2012;29(1):505.
3.
7.
12. Holick MF. Diabetes and the vitamin D connection. Curr Diab Rep.
2008;8(5):3938.
13. Lee P, Chen R. Vitamin D as an analgesic for patients with type 2 diabetes
and neuropathic pain. Arch Intern Med. 2008;168(7):7712.
14. Shehab D, Al-Jarallah K, Abdella N, et al. 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):2506.
Parameters
Before
After
Differences
P-value
NSS
Treatment
5.92 1.29
4.43 1.58
1.49 1.37
Placebo
5.50 1.25
5.45 1.20
0.20 0.59
Treatment
8.4 1.8
8.4 1.8
0.42 1.59
Placebo
7.8 1.9
7.7 1.8
0.03 0.2
<0.001
NDS
0.094
Treatment
25.3 10.9
58.2 23.8
32.8 23.7
Placebo
29.2 9.5
30.3 8.9
1.1 3.6
116 27
50
Values represent mean SD.The Mann-Whitney U test was used. The minus sign
indicates that the values decreased after treatment.
Neurons
are
protected
from
apoptosis
and
neurodegeneration due to these effects of vitamin D,
resulting in increased transcription activity of VDR-target
genes.
SUMMARY
Diabetic neuropathy (nerve disorders caused by diabetes)
is the major cause of morbidity in diabetes.
2.
3.
4.
5.
6.
7.
39 11
0
Peanut oil capsules
(fasting)
Medium chain
triglyceride capsules
(fasting)
Treatment
<0.0001
1.
100
25(OH)D, mmol/l
REFERENCES
150
Vitamin D (nmol/L)
Conclusion
With reference to clinical studies, it is evident that oilbased formulations of vitamin D greatly increase its serum
concentration in the body compared to solid formulations
in diabetics. It can thus be concluded that to obtain
improved insulin sensitivity for diabetes patients, oilbased vitamin D3 supplements may prove to be an addon treatment option. In addition, peanut oil can be the
preferred lipid vehicle.
Variable
Value
No. of subjects
SR.
NO.
TOPICS
MONTH
April
May
June
Sex, No.
Female
37
Male
14
Age, y
Weight, kga
BMI
July
August
79.7 (9.8)
September
October
November
18 (3)
a
32.2 (17.1)
3.3 (0.7)
32.1 (4.6)
a
30 (5)
a
MPQ score at 3 mo
28.1 (10.0)
1.7 (0.8)
19.4 (7.4)
December
+67.4
10
January
13.4
11
February
48.5b
39.4b
12
March
30.0 (2.3)
62 (13)
51
Case 1
A 63-year-old woman with 25(OH)D level of 12 ng/mL and
HbA1c levels stable at 8.4%, received 2000 IU of vitamin D3
per day and was increased to 3000 IU/d.
Case 2
Over the past decades, numerous non-skeletal diseases are found to be associated with vitamin D
deficiency including type 2 diabetes mellitus (T2DM).1 Diabetic neuropathy is one such condition.
Around 6070% diabetic patients have some form of neuropathy.2 Hyperglycaemic state leads to
increased activity of enzymes aldose reductase and sorbitol dehydrogenase, and oxidative stress
which contributes to nerve cell dysfunction.3
There are various studies which have shown a role of vitamin D supplementation in glucose
tolerance through its effects on insulin secretion and insulin sensitivity.1 Activity of vitamin D as
an analgesic is also highlighted, suggesting its role in diabetic neuropathy for reducing
neuropathic pain.
This scientific input mainly focuses on the link between vitamin D deficiency and diabetic
neuropathy and importance of vitamin D supplementation as add-on treatment. We hope that
the information provided will help doctors to enhance patient care.
REFERENCES
1.
Talaei A, Mohamadi M, Adgi Z. The effect of vitamin D on insulin resistance in patients with type 2 diabetes.
Diabetol Metab Syndr. 2013;5(1):8.
2.
Bell DSH. Reversal of the symptoms of diabetic neuropathy through correction of vitamin D deficiency in a type 1
diabetic patient. Case Reports in Endocrinology. 2012;Article ID 165056:3 pages.
3.
Clayton W, Elasy TA. A review of the pathophysiology, classification, and treatment of foot ulcers in diabetic
patients. Clinical Diabetes. 2009;27(2):528.
Significant improvements were seen in HbA1c and HOMAIR after supplementation (Table 1).
7
8
5
8
Decrease in HOMA-IR
Intervention
Control
P- value
63
53
P < 0.05
63
53
P < 0.05
53
43
P < 0.05
Study 18
Study 26
The frequency of low 25(OH)D levels among 111 diabetics
suffering from peripheral neuropathy was evaluated in a
study.
Neuropathy was confirmed in 55.8% of type 2 diabetic
patients.
Lipid alterations
Cardiovascular risk factors
Hyperglycaemia
Increased extracellular
protein glycation
AGE formation
RAGE activation
Sugar + ROSs carbonyls
Carbonyls + proteins or
lipids glycoxidation or
lipoxidation products
Oxidative stress
Increased glycolysis
and TCA cycle activity
Mitochondrial
dysfunction
Increased
diacylglycerol
Protein + glucose
AGEs
50
Patients (%)
60
50
37
40
38
30
20
10
Paresthesia
Tingling
Numbness
Insensitive feet
Neuropathy symptoms