Vitamin D and Nerve Conduction In Pediatric Type-1 Diabetes Mellitus

Prevalence of Vitamin D Deficiency in Children and Adolescents With Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Our systematic review and meta-analysis examined the proportion of vitamin D deficiency in children and adolescents with type 1 diabetes mellitus (T1DM). We conducted a comprehensive literature search across multiple databases, including PubMed, Cochrane Library, Web of Science, Ovid Medline, and Embase, for studies published between January 2016 and March 2025. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 29 studies comprising 2516 participants were included in the final analysis. Quality assessment was performed using the Newcastle-Ottawa Scale. The pooled analysis revealed that 46% (95% CI: 34-58%) of children and adolescents with T1DM had vitamin D deficiency, with significant heterogeneity observed across studies (I² = 97.98%, p<0.01). Subgroup analysis showed geographical variations with the highest deficiency rates in Africa (74%). The definition of vitamin D deficiency also impacted results, with cutoffs of <25 ng/mL yielding the highest proportion (80%) and <12 ng/mL the lowest (14%). Despite methodological limitations, including clinical setting bias, varied study designs, and inconsistent deficiency thresholds, our findings highlight the substantial burden of vitamin D deficiency in pediatric T1DM patients. This suggests the need for routine screening and potential supplementation strategies, though further research is required to establish optimal vitamin D levels for T1DM management and determine whether supplementation could play a preventive or therapeutic role in this population.

Assessment of nerve conduction studies in insulin-dependent diabetes in children and adolescents at the tertiary care center in eastern Nepal

Background

Young adults suffering from Type 1 Diabetes mellitus may have diabetic peripheral neuropathy without any signs and symptoms, as one of the complications. Nerve conduction study is routinely used for evaluation of neuromuscular function. This study aimed to conduct a nerve conduction study in insulin-dependent type 1 diabetes mellitus in children and adolescents.

Methods

It was a cross-sectional, descriptive study conducted on 16 diagnosed cases of diabetes mellitus in children aged between 5-15 years and 16 healthy controls. Children were selected based on inclusion criteria from Pediatric and adolescent diabetic clinics who came for follow-up. A motor nerve conduction study of the median, tibial, and common peroneal nerves was recorded, and a sensory nerve conduction study of the median and sural nerves was recorded.

Results

The percentage of females was 46.4% and males were 53.6%. The age of diabetic children was (mean ± SD) 9.75 ± 3.53 and healthy control was 10.75 ± 3.14. A comparison of sensory nerve conduction parameters between type one diabetes in children and healthy control; onset latency of the sural nerve was prolonged on the bilateral side in diabetes children. Similarly, the SNAP amplitude of the median and sural nerves was decreased in diabetes children.

Conclusions

In type 1 diabetes in children, peripheral nerves get affected even in asymptomatic patients in children. More disease duration and uncontrolled glucose levels will lead to the involvement of nerves getting affected. Proper follow-up is needed for better management.

The impact of vitamin D on the etiopathogenesis and the progression of type 1 and type 2 diabetes in children and adults

Diabetes is a common chronic metabolic disease with complex causes and pathogenesis. As an immunomodulator, vitamin D has recently become a research hotspot in the occurrence and development of diabetes and its complications. Many studies have shown that vitamin D can reduce the occurrence of diabetes and delay the progression of diabetes complications, and vitamin D can reduce oxidative stress, inhibit iron apoptosis, promote Ca2+ influx, promote insulin secretion, and reduce insulin resistance. Therefore, the prevention and correction of vitamin D deficiency is very necessary for diabetic patients, but further research is needed to confirm what serum levels of vitamin D3 are maintained in the body. This article provides a brief review of the relationship between vitamin D and diabetes, including its acute and chronic complications.

Neurophysiological Characteristics in Type II and Type III 5q Spinal Muscular Atrophy Patients: Impact of Nusinersen Treatment

Objective

This study aimed to observe the neurophysiological characteristics of type II and type III 5q spinal muscular atrophy (SMA) patients and the changes in peripheral motor nerve electrophysiology after Nusinersen treatment, as well as the influencing factors.

Methods

This single-center retrospective case-control study collected clinical data and peripheral motor nerve CMAP parameters from 42 5qSMA patients and 42 healthy controls at the Second Affiliated Hospital of Xi'an Jiaotong University (January 2021 to December 2022). It evaluated changes in motor function and CMAP amplitude before and after Nusinersen treatment.

Results

Our investigation encompassed all symptomatic and genetically confirmed SMA patients, consisting of 32 type II and 10 type III cases, with a median age of 57 months (29.5 to 96 months). Comparative analysis with healthy controls revealed substantial reductions in CMAP amplitudes across various nerves in both type II and type III patients. Despite the administration of Nusinersen treatment for 6 or 14 months to the entire cohort, discernible alterations in motor nerve amplitudes were not observed, except for a significant improvement in younger patients (≤36 months) at the 14-month mark. Further scrutiny within the type II subgroup unveiled that individuals with a disease duration ≤12 months experienced a noteworthy upswing in femoral nerve amplitude, a statistically significant difference when compared to those with >12 months of disease duration.

Conclusion

Motor nerve amplitudes were significantly decreased in type II and type III 5q SMA patients compared to healthy controls. Nusinersen treatment showed better improvement in motor nerve amplitudes in younger age groups and those with shorter disease duration, indicating a treatment-time dependence.

Proportion of vitamin D deficiency in children/adolescents with type 1 diabetes: a systematic review and meta-analysis

BACKGROUND

The impact of vitamin D on type 1 diabetes has been a controversial topic in public health. Furthermore, significant differences in the proportion of vitamin D have been noted. The purpose of this systematic review was to determine the overall proportion of vitamin D deficiency in children/adolescents with type 1 diabetes (T1D).

METHODS

Based on six electronic databases (PubMed, Web of Science, Embase, Ovid Medline, ProQuest, and Cochrane Library), eligible studies since the databases' inception up to April 2022 were searched. Reference lists were also manually searched to identify additional studies. Overall, studies with statistical information on vitamin D deficiency in children and adolescents with T1D were included, and a random effects model was applied for the meta-analysis. In addition, subgroup and sensitivity analyses were carried out to evaluate heterogeneity, and publication bias was evaluated by using Egger's test.

RESULTS

A total of 45 studies involving 6,995 participants met the inclusion criteria; these included 25 countries covering Africa, Oceania, Europe, North America and Asia. The proportion of vitamin D deficiency in children/adolescents with T1D was 45% (95% confidence interval [CI] 37-54%, I2 = 97.94%). Subgroup analysis further revealed that the publication year, study design, vitamin D classification, season and geographical region significantly contributed to the variation in the reported incidence of vitamin D deficiency.

CONCLUSIONS

The results of the meta-analysis showed that the proportion of vitamin D deficiency among T1D children/adolescents was 45%. In addition, the proportion remains higher, which has important implications for adapting health and social care systems.

Slowing of Peripheral Nerve Conduction Velocity in Children and Adolescents With Type 1 Diabetes Is Predicted by Glucose Fluctuations

Nerve conduction velocity (NCV) abnormalities are the forerunners of diabetic peripheral neuropathy (DPN). Therefore, this study aimed to analyze the effect of glucose profile quality on NCV in children and young adults with type 1 diabetes. Fifty-three children age 5 to 23 years with type 1 diabetes were recruited to participate in the study, which was conducted prospectively at the Children's Hospital of Eastern Switzerland from 2016 to 2022. Glycemic targets were recorded, and a cross-sectional nerve conduction study analyzing the peroneal, tibial, median motor, and median sensory nerves was performed. Data were compared with those of a control group of 50 healthy children. In the age- and height-matched diabetes subgroup aged 10-16 years, all four nerves showed significantly slower NCV, most pronounced for the peroneal nerve. Because height has a retarding effect on peroneal NCV, NCV was adjusted for height (dNCV). Peroneal dNCV correlated negatively with long-term glycated hemoglobin and highly significantly with glucose variability. Because high glucose variability clearly increases the risk of neuropathy, together with but also independently of the mean glucose level, this aspect of glycemic control should be given more attention in the care of individuals with diabetes.

ARTICLE HIGHLIGHTS

There is a strong need for the better identification of early subclinical manifestations of microvascular complications, such as diabetic peripheral neuropathy, in young individuals with diabetes. To identify peripheral neuropathy and contributing factors at an asymptomatic disease stage, and to exclude height as a known modifying factor, we performed association studies of height-adjusted nerve conduction velocity. We identified high glucose variability, especially the SD of mean glucose, as an unexpectedly strong predictor of slowed nerve conduction velocity. More attention should be paid to the goal of low glucose variability in the care of individuals with diabetes.

Vitamins in neuropathy: pathophysiological and therapeutic roles

PURPOSE OF REVIEW

Vitamin deficiency is a risk factor in the development of peripheral neuropathy, which leads to complex and severe diseases. This review provides an update overview of the literature on the roles of vitamins in peripheral neuropathy, highlighting their pathophysiological and therapeutic roles.

RECENT FINDINGS

The importance and clinical manifestations and implications of the vitamins and vitamin deficiencies are further demonstrated in peripheral neuropathy and the associated diseases. Vitamin deficiency is common in various severe and complex diseases such as diabetes, chemotherapy, acute nutritional axonal neuropathy, dermatitis, complex regional pain syndrome, postherpetic neuralgia, carpal tunnel syndrome, and so forth and some rare clinical case reports. There is evidence that deficiencies of almost all vitamins are associated with diabetic neuropathy. Vitamin supplementation may serve as an effective therapeutic strategy.

SUMMARY

The vitamins play critical roles in maintaining physiological functions, and vitamin deficiencies cause peripheral neuropathy with various severe and complex diseases. The therapeutic benefits of vitamins and further understanding of the mechanisms for vitamin treatment effects should be emphasized and highlighted. More clinical trials are needed to establish optimal treatment strategies for vitamins in the various neuropathies. A large range of people/patients screening for vitamin deficiencies may be considered in order to provide early diagnosis and timely medical assistance.