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Objective <p>This study aimed to examine the associations of serum 25-hydroxyvitamin D [25(OH)D] and immune-inflammatory indices with electrophysiological diabetic peripheral neuropathy (DPN) and nerve action potential amplitudes in patients with newly diagnosed type 2 diabetes mellitus (T2DM) and requirement for short-term intensive insulin therapy.</p> Methods <p>This retrospective study included hospitalized patients with newly diagnosed T2DM who required short-term intensive insulin therapy and underwent standardized nerve conduction studies. Electrophysiological DPN was defined using prespecified nerve conduction criteria after excluding other etiologies. Serum 25(OH)D, neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) were compared between patients with and without electrophysiological DPN. Exploratory multivariable linear regression analyses were performed among patients with electrophysiological DPN to assess factors associated with lower-limb motor CMAP amplitudes. Exploratory mediation analyses were performed to assess potential indirect associations through NLR and SII.</p> Results <p>Among 177 patients included, 34 had electrophysiological DPN, and 143 did not. Compared with patients without electrophysiological DPN, those with electrophysiological DPN had lower serum 25(OH)D levels (15.35 ± 4.98 vs 19.50 ± 4.10&#xa0;ng/mL, <i>P</i> &lt; 0.001), higher NLR and SII levels, and reduced motor CMAP and sensory SNAP amplitudes (all <i>P</i> &lt; 0.05). Among patients with electrophysiological DPN, higher 25(OH)D was independently associated with higher tibial CMAP amplitudes with ankle stimulation (<i>β</i> = 0.262, 95% CI 0.049 to 0.475, <i>P</i> = 0.018; standardized <i>β</i> = 0.399). Higher SII was independently associated with lower common peroneal CMAP amplitudes with ankle stimulation (<i>β</i> = −&#xa0;0.003, 95% CI −&#xa0;0.006 to −&#xa0;0.000, <i>P</i> = 0.041; standardized <i>β</i> = −&#xa0;0.394). NLR showed an inverse but insignificant association with common peroneal CMAP amplitudes after adjustment. Exploratory mediation analyses showed no significant indirect associations through NLR or SII.</p> Conclusion <p>In newly diagnosed T2DM patients requiring short-term intensive insulin therapy, electrophysiological DPN was associated with lower serum 25(OH)D, higher immune-inflammatory indices, and reduced nerve action potential amplitudes. Among patients with electrophysiological DPN, 25(OH)D and SII were associated with lower-limb motor CMAP amplitudes. Exploratory mediation analyses did not find significant indirect associations through NLR or SII.</p>

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Serum 25-hydroxyvitamin D, immune-inflammatory indices, and electrophysiological diabetic peripheral neuropathy in newly diagnosed type 2 diabetes patients requiring short-term intensive insulin therapy

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  • 发表日期：

    2026年7月3日

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  • Xiaxia Zhang,
  • Fei He,
  • Yingying Pan,
  • Qiao Ying

摘要

Objective

This study aimed to examine the associations of serum 25-hydroxyvitamin D [25(OH)D] and immune-inflammatory indices with electrophysiological diabetic peripheral neuropathy (DPN) and nerve action potential amplitudes in patients with newly diagnosed type 2 diabetes mellitus (T2DM) and requirement for short-term intensive insulin therapy.

Methods

This retrospective study included hospitalized patients with newly diagnosed T2DM who required short-term intensive insulin therapy and underwent standardized nerve conduction studies. Electrophysiological DPN was defined using prespecified nerve conduction criteria after excluding other etiologies. Serum 25(OH)D, neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) were compared between patients with and without electrophysiological DPN. Exploratory multivariable linear regression analyses were performed among patients with electrophysiological DPN to assess factors associated with lower-limb motor CMAP amplitudes. Exploratory mediation analyses were performed to assess potential indirect associations through NLR and SII.

Results

Among 177 patients included, 34 had electrophysiological DPN, and 143 did not. Compared with patients without electrophysiological DPN, those with electrophysiological DPN had lower serum 25(OH)D levels (15.35 ± 4.98 vs 19.50 ± 4.10 ng/mL, P < 0.001), higher NLR and SII levels, and reduced motor CMAP and sensory SNAP amplitudes (all P < 0.05). Among patients with electrophysiological DPN, higher 25(OH)D was independently associated with higher tibial CMAP amplitudes with ankle stimulation (β = 0.262, 95% CI 0.049 to 0.475, P = 0.018; standardized β = 0.399). Higher SII was independently associated with lower common peroneal CMAP amplitudes with ankle stimulation (β = − 0.003, 95% CI − 0.006 to − 0.000, P = 0.041; standardized β = − 0.394). NLR showed an inverse but insignificant association with common peroneal CMAP amplitudes after adjustment. Exploratory mediation analyses showed no significant indirect associations through NLR or SII.

Conclusion

In newly diagnosed T2DM patients requiring short-term intensive insulin therapy, electrophysiological DPN was associated with lower serum 25(OH)D, higher immune-inflammatory indices, and reduced nerve action potential amplitudes. Among patients with electrophysiological DPN, 25(OH)D and SII were associated with lower-limb motor CMAP amplitudes. Exploratory mediation analyses did not find significant indirect associations through NLR or SII.