Frontiers in endocrinology · 2026
Vitamin D and cardiovascular autonomic neuropathy in type 2 diabetes mellitus according to diabetic kidney disease stage.
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Felício João, Chambouleyron Ester, Nascimento Valéria, Fernandes Isabel, Ruivo Lícia, Hupp Maria Vitória, Silva Lilian, de Queiroz Natércia, de Melo Franciane, de Souza Ana Carolina, Dos Santos Márcia, de Moraes Lorena, Barros Mayana, Pinheiro Danielle, do Carmo Maria Eduarda, Lobo Beatriz, Piani Pedro, Motta Ana Regina, Dos Reis Melissa, Leal Valéria Suênya, de Figueiredo Priscila, Felício Karem
Аннотация
BACKGROUND/OBJECTIVES: Cardiovascular autonomic neuropathy (CAN) may be associated with other diabetes mellitus-related complications. In addition, lower vitamin D (VD) levels have been associated with diabetic kidney disease (DKD) and diabetic neuropathy. We evaluated the relationship between serum VD and CAN in patients with type 2 Diabetes Mellitus (T2DM) in early and advanced stages of DKD.
METHODS: Seventy-six T2DM patients, 28 in early DKD stage (urine albumin to creatinine ratio (UACR)): 30 to 299 mg/g - group 1), and 48 in advanced DKD stage (UACR ≥300 mg/g - group 2), participated.
RESULTS: In group 1, prevalence of CAN was 46% versus 75% in group 2 (p=0.01). 25(OH)D was lower in group 2 (26.3 ± 9.8 vs 30.0 ± 8.0; p<0.05) and, in this group, those with CAN vs without CAN showed lower 25(OH)D (27.8 ± 8.3 vs 32 ± 6.3; p<0.05). Only in group 2, patients with VD deficiency (<no><20</no> ng/ml) vs normal, showed worse CAN parameters, particularly VLF (65.5 (46-104) vs 309 (106.5-682.5), p<0.01), SDNN (10.5 (8-17.5) vs 28.5 (13-48), p<0.05) and Valsalva Maneuver (1.12 ± 0.04 vs 1.30 ± 0.21, p<0.05). We have found a correlation between VD concentration and CAN prevalence (r = -0.3, p<0.05). Logistic regression showed that VD concentration <no><20</no> ng/ml increased 24 times the chance of abnormal VLF (R²: 0.38; OR: 24.1; 95% (CI: 2.6-222); p<0.01).
CONCLUSIONS: To our knowledge, this is the first study to demonstrate an association between lower VD and CAN in T2DM and advanced DKD.
METHODS: Seventy-six T2DM patients, 28 in early DKD stage (urine albumin to creatinine ratio (UACR)): 30 to 299 mg/g - group 1), and 48 in advanced DKD stage (UACR ≥300 mg/g - group 2), participated.
RESULTS: In group 1, prevalence of CAN was 46% versus 75% in group 2 (p=0.01). 25(OH)D was lower in group 2 (26.3 ± 9.8 vs 30.0 ± 8.0; p<0.05) and, in this group, those with CAN vs without CAN showed lower 25(OH)D (27.8 ± 8.3 vs 32 ± 6.3; p<0.05). Only in group 2, patients with VD deficiency (<no><20</no> ng/ml) vs normal, showed worse CAN parameters, particularly VLF (65.5 (46-104) vs 309 (106.5-682.5), p<0.01), SDNN (10.5 (8-17.5) vs 28.5 (13-48), p<0.05) and Valsalva Maneuver (1.12 ± 0.04 vs 1.30 ± 0.21, p<0.05). We have found a correlation between VD concentration and CAN prevalence (r = -0.3, p<0.05). Logistic regression showed that VD concentration <no><20</no> ng/ml increased 24 times the chance of abnormal VLF (R²: 0.38; OR: 24.1; 95% (CI: 2.6-222); p<0.01).
CONCLUSIONS: To our knowledge, this is the first study to demonstrate an association between lower VD and CAN in T2DM and advanced DKD.