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We have evaluated vitamin D levels in diabetic patients with and without painful neuropathy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Forty\u2010three patients with type 1 diabetes and painless (DPN) (n = 20) or painful (PDN) (n = 23) neuropathy and 14 non\u2010diabetic healthy control subjects (C) underwent assessment of neurologic deficits, quantitative sensory testing (QST), electrophysiology, skin biopsy, corneal confocal microscopy (CCM) and measurement of serum 25(OH)D.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were no significant differences for age, BMI, HbA<jats:sub>1c<\/jats:sub>, lipids, neurological deficits, QST, electrophysiology, intra\u2010epidermal nerve fibre density (IENFD) and corneal nerve morphology between patients with DPN and PDN. Both positive (hyperalgesia and allodynia) and negative symptoms (paraesthesia and numbness) of diabetic neuropathy were greater in PDN compared with DPN (<jats:italic>P<\/jats:italic>= .009 and<jats:italic>P<\/jats:italic>= .02, respectively). Serum 25(OH)D levels were significantly lower in PDN (24.0\u2009\u00b1\u200914.1 ng\/mL) compared with DPN (34.6\u2009\u00b1\u200915.0 ng\/mL,<jats:italic>P<\/jats:italic>= .01) and controls (34.1\u2009\u00b1\u20098.6 ng\/mL,<jats:italic>P<\/jats:italic>= .03). The odds ratio in favour of painful diabetic neuropathy was 9.8 [<jats:italic>P<\/jats:italic>= .003 (95% CI, 2.2\u201376.4)] for vitamin D deficiency (&lt;20\u2009ng\/mL) and 4.4 [<jats:italic>P<\/jats:italic>= .03 (95% CI, 1.1\u201019.8)] for vitamin D insufficiency (&lt;30\u2009ng\/mL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study suggests that vitamin D deficiency and insufficiency are associated with painful diabetic neuropathy.<\/jats:p><\/jats:sec>","DOI":"10.1002\/dmrr.3361","type":"journal-article","created":{"date-parts":[[2020,6,7]],"date-time":"2020-06-07T14:12:03Z","timestamp":1591539123000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Vitamin D deficiency is associated with painful diabetic neuropathy"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3190-1122","authenticated-orcid":false,"given":"Uazman","family":"Alam","sequence":"first","affiliation":[{"name":"Department of Cardiovascular &amp; Metabolic Medicine and the Pain Research Institute, Institute of Life Course and Medical Sciences University of Liverpool Liverpool UK"},{"name":"Department of Diabetes, Endocrinology &amp; Gastroenterology, Faculty of Biology, Medicine and Health University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis N.","family":"Petropoulos","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine\u2010Qatar, Research Division, Qatar Foundation Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6936-1248","authenticated-orcid":false,"given":"Georgios","family":"Ponirakis","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine\u2010Qatar, Research Division, Qatar Foundation Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Ferdousi","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences University of Manchester and NIHR Clinical Research Facility Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Asghar","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences University of Manchester and NIHR Clinical Research Facility Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Jeziorska","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences University of Manchester and NIHR Clinical Research Facility Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Marshall","sequence":"additional","affiliation":[{"name":"Pain Research Institute, Institute of Life Course and Medical Sciences University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J. 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