Background: Diabetic retinopathy is the most severe ocular complication of diabetes. Despite the known association of low vitamin D level with insulin resistance and diabetes, findings of recent studies on the association of vitamin D deficiency with macrovascular and microvascular complications of diabetes have been somewhat ambiguous and contradictory. 
Objectives: To determine the relationship between serum levels of vitamin D and different types of retinopathy in patients with type 2 diabetes.
Methods: This case-control study examined 192 patients with type 2 diabetes who regularly attended the ophthalmologic clinic in 5th AZAR Hospital at Golestan University Medical Center in Gorgan (Iran) from September 25, 2015 to March 15, 2016. Patients were allocated into three matched groups: PDR, NPDR, and control (without retinopathy) (64 participants per group). A questionnaire was used for demographic and general data such as age, gender, height, weight, body mass index, and blood pressure. Fasting venous blood samples were obtained for measuring serum levels of glucose, HbA1c, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, urea, creatinine, and 25-hydroxy vitamin D. A vitreoretinal surgeon performed retinal examination through dilated pupils using slit lamp. The data were analyzed using SPSS v16. Chi-square, ANOVA, Kruskal-Wallis and Logistic Regression were used for data analysis. P-values <0.05 were considered significant.  
Results: The mean serum vitamin D level in the PDR, NPDR and control groups were 23.89 (±12.36), 28.18 (±14.99) and 30.24 (±13.85) ng/ml, respectively. According to results of ANOVA, Ln vitamin D differed significantly between the three groups (p=0.007), and pairwise comparisons indicated a significant difference between PDR patients and controls (PP=0.005). The results of logistic regression analysis indicated a 2.4-fold higher risk of vitamin D deficiency in the retinopathy group compared to the control group (OR =2.409, CI (95%): 1.15-5.01).
Conclusion: This study revealed that vitamin D deficiency is significantly associated with the incidence of proliferative retinopathy.
Keywords: Vitamin D, Diabetic Neuropathies, Diabetes Mellitus Type 2


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