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Vitamin B12 Supplementation in Diabetic Neuropathy

Diabetic neuropathy (DN) is one of the most common complications of diabetes. At the time of diagnosis of diabetes, 10–18% of patients present with nerve damage, neuropathy can occur even in prediabetes and is associated with foot infections, ulcers, Charcot arthropathy, fractures, and amputations. Strict glycemic control has been considered to be the cornerstone of the treatment of DN. However, it has only modest effects on the progression of DN. It is of particular note that strict glycemic control needs to be maintained for three-to-five years to provide any clinical benefit.In addition to any antiglycemic therapy aiming at strict glycemic control, vitamin B12 (B12) has been probably the most commonly used supplement. The first reason is that vitamin B12 deficiency is quite common in patients with DM2, and the second is that vitamin B12 deficiency may cause neurological disorders, such as peripheral, autonomic (including cardiovascular), and painful neuropathy.

Ninety adult patients were enrolled in a RCT study to investigate the efficacy of normalizing vitamin B12 levels with 1000 µg of methylcobalamin daily in DM2 patients with good glycemic control and generalized neuropathy.B12 supplementation resulted in improvements of somatosensory symptoms such as pain and paresthesia.Unexpectedly, the active treatment group did not show a significant improvement in cardiovascular autonomic reflex tests. This study showed that the increase of B12 levels with an oral dispersible tablet containing 1000 µg methylcobalamin for 12 months in patients with DN improved the patients’ neurophysiological parameters, sudomotor function, pain score, and Quality of Life .


Vitamin B12 Supplementation in Diabetic Neuropathy: A 1-Year, Randomized, Double-Blind, Placebo-Controlled Trial  


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