BACKGROUND Vitamin D deficiency has been reported to be associated with diabetic peripheral neuropathy (DPN). Our objective here was to evaluate the association between vitamin D levels and neuropathic symptoms in a Chinese population. MATERIAL AND METHODS A total of 4435 patients with type 2 diabetes (T2D) were recruited in this cross-sectional study. 25-dihydroxyvitamin D (25-(OH) D) serum concentration was measured by electrochemiluminescence assay (Cobas e601, Roche). DPN was clinically diagnosed by assessing neurological symptoms and performing current perception threshold (CPT) testing. Of all the patients, 2910 were CPT-positive and had assessed neurological symptoms. RESULTS In the vitamin D insufficiency group (<30 ng/mL 25-(OH) D), patients with neurological symptoms had higher serum 25-(OH) D levels than those without neurological symptoms (24.65±3.42 ng/mL vs 23.61±4.54 ng/mL, p≤0.001). The risk of numbness and pain increased by 0.5-fold for every 6 ng/mL increase in 25-(OH) D. In the vitamin D sufficiency group (≥30 ng/mL 25-(OH) D), patients with neurological symptoms had lower serum 25-(OH) D levels than those without neurological symptoms (32.96±3.18 ng/mL vs 33.45±4.27 ng/mL, p<0.01). For every 4 ng/mL decrease in 25-(OH) D, the risk of numbness and pain increased by 0.2-fold. CONCLUSIONS The association of neuropathy symptoms with 25-(OH) D levels differed depending on whether the patients had insufficient or sufficient vitamin D.