We talk a lot about the big-ticket items in diabetic peripheral neuropathy (DPN)—glucose control, hemoglobin A1c, advanced glycation end products. But what about the stuff sitting quietly in your multivitamin? A new review from Ntoga and colleagues out of the Diabetic Foot Clinic at Democritus University of Thrace—working with collaborators at Aristotle University of Thessaloniki—makes a compelling case that we should be paying much closer attention to the fat-soluble vitamins A, D, and E in our patients with DPN.
Published in the International Journal of Lower Extremity Wounds (DOI: 10.1177/15347346251415253), the review lays out the neuroprotective mechanisms of each vitamin with refreshing clarity. Vitamin A appears to regulate nerve growth factor (NGF) expression—the stuff that’s essential for peripheral neuron development, survival, and regeneration. Vitamin D brings immunomodulatory firepower, tamping down pro-inflammatory cytokines and boosting neuroplasticity. And vitamin E, through its well-known antioxidant action, helps mop up reactive oxygen species (ROS) that drive the demyelinating lesions we see in DPN.
What’s particularly interesting here is the supplementation data. The authors report that correcting these deficiencies has shown potential for symptom improvement—and in some cases, reversal. That’s a big word in neuropathy. We don’t use “reversal” very often.
The clinical takeaway? Screen early. Correct deficiencies. And think of vitamin optimization not as an afterthought, but as an integral part of a comprehensive DPN prevention and management strategy. It’s not going to replace the fundamentals of glycemic control and offloading, but it may be an important—and underappreciated—piece of the puzzle.
Nice work by Ntoga M, Stamatiou I, Kotsa K, Liakopoulos V, and Papanas N. Our friend Nikolaos Papanas continues to be one of the most prolific contributors to the diabetic foot literature. Keep it coming, team.
Reference: Ntoga M, Stamatiou I, Kotsa K, Liakopoulos V, Papanas N. The Role of Vitamins A, D, and E in Diabetic Peripheral Neuropathy. Int J Low Extrem Wounds. 2026 Feb 20:15347346251415253. doi: 10.1177/15347346251415253. PMID: 41719171.
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