Assessment of Vitamin B12 deficiency and peripheral neuropathy in patients with diabetes
Dr. Prabhat Kumar Sinha
The extended use of metformin, accompanied by vitamin B12 deficiency, may lead to increasing the considerable problem of peripheral neuropathy in non-insulin-dependent diabetes mellitus (NIDDM) patients. Neuropathy, being an impending health abnormality occurring due to vitamin B12 deficiency affects around 30% diabetics who are over 40 years of age and state about having a diminished sensory perception in their feet. Based on the above findings the present study was planned to evaluate the association between vitamin B12 deficiency and peripheral neuropathy in patients with diabetes. The current study was planned in the Department of Medicine in Darbhanga Medical College. Total 25 patients of the diabetes with peripheral neuropathy and 25 control patients with diabetes only were enrolled in the present study. The serum vitamin B12 concentration was evaluated in all the patients. Patients were defined as type 2 diabetes if they met the American Diabetic Association criteria with an age at diagnosis above 30 years. Serum vitamin B12 levels of the patients were determined using high performance liquid chromatography (HPLC). The present study concludes that metformin use in Type 2 diabetes patients is associated with B12 deficiency and worsening clinical neuropathy, which is a dose-dependent effect. Hence we suggest for screening of B12 levels in long-term metformin users and treating them if they are deficient. The metformin use was associated with a significantly lower serum Vitamin B12 levels when adjusted for duration of diabetes. Serum Vitamin B12 deficient patients did not have a higher prevalence of anemia or neuropathy. Further study of the impact of duration of diabetes on serum Vitamin B12 levels and of functional markers of Vitamin B12 deficiency on haematological and neurological parameters will be interesting.