scholarly journals Vitamin B12 and Holotranscobalamin Levels in Diabetic Peripheral Neuropathy Patients

2016 ◽  
Vol 20 (1) ◽  
pp. 16-20
Author(s):  
Mohammed Noorjahan ◽  
Kandregula Madhavi ◽  
Chandran Priscilla ◽  
Shaik A Jabeen
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Neuropathy ◽  
Vitamin B12 ◽  
Diabetic Peripheral Neuropathy ◽  
Vitamin B12 Deficiency ◽  
Biologically Active ◽  
Significant Difference ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation

ABSTRACT Diabetic neuropathy is the most common and debilitating microvascular complication leading to nontraumatic amputations. Identifying the role of vitamin B12 in the etiology of neuropathy is crucial because simple vitamin B12 replacement may reverse neurologic symptoms if confirmed. Large proportion of vegetarians and patients on metformin have been associated with lowering of vitamin B12 levels. We have undertaken study on 60 vegetarian subjects between the age of 30 and 60 years, 20 healthy controls, 20 type 2 diabetes mellitus patients who were on metformin with peripheral neuropathy (DMWN), and 20 diabetics without peripheral neuropathy (DMWON). Vitamin B12, homocysteine, and folate levels were measured, and holotranscobalamin (holoTC) is also included, to improve the diagnosis of tissue vitamin B12 status, as holoTC is the biologically active fraction and more sensitive index of vitamin B12 status than total vitamin B12 itself. Complete history and clinical evaluation for neuropathy and electroneuromyography were recorded. Results In the DMWN group, vitamin B12 levels were significantly higher than in the DMWON group and controls [1013 (564-1501) pmol/l, 387 (245-731) pmol/l, and 305 (234-472) pmol/l respectively]. Similarly, serum holoTC was also found to be significantly higher in the DMWN [203.8 (129-300) pmol/l] group compared with the DMWON [94.4 (42.2-230.6) pmol/l] group and controls [74 (40-170) pmol/l]. Whereas mean levels of homocysteine and folate did not show any significant difference between groups, significant increase in fasting blood sugar and HbA1c was seen in the DMWN group compared with DMWON group and controls. Duration of diabetes is also significantly more in DMWN group compared with DMWON group. Conclusion We found that vitamin B12 and holoTC levels were high in patients with DMWN and DMWON groups compared with controls. Our study demonstrated that peripheral neuropathy was not associated with vitamin B12 deficiency in diabetics. These findings merit further research on a larger population to investigate into the cause of diabetic neuropathy, the factors involved, and benefit of vitamin B12 supplementation in these patients. Key messages Vitamin B12 status has no association with diabetic peripheral neuropathy. How to cite this article Noorjahan M, Madhavi K, Priscilla C, Jabeen SA. Vitamin B12 and Holotranscobalamin Levels in Diabetic Peripheral Neuropathy Patients. Indian J Med Biochem 2016;20(1):16-20.

scholarly journals Profiling immuno-metabolic mediators of vitamin B12 deficiency among metformin-treated type 2 diabetic patients in Ghana

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0249325
Author(s):  
Samuel Asamoah Sakyi ◽  
Edwin Ferguson Laing ◽  
Richard Mantey ◽  
Alexander Kwarteng ◽  
Eddie-Williams Owiredu ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Neuropathy ◽  
Vitamin B12 ◽  
Intrinsic Factor ◽  
Vitamin B12 Deficiency ◽  
Anthropometric Measurement ◽  
Diabetic Patients ◽  
Vitamin B ◽  
Tnf Α ◽  
B12 Deficiency

Background The association between prolong metformin usage and B12 deficiency has been documented. However, the prevalence estimates of metformin-induced vitamin B12 deficiency showed substantial disparity among studies due to varied study definitions of vitamin B12 deficiency. Metformin blocks the calcium dependent absorption of the vitamin B12-Intrinsic Factor complex at the terminal ileum. Lack of intrinsic factor due to the presence of auto-antibodies to parietal cells (IFA) could lead to vitamin B12 deficiency and subsequently cause peripheral neuropathy. We investigated the prevalence of vitamin B12 deficiency using more sensitive, combined markers of vitamin B12 status (4cB12) and the immuno-biochemical mediators of vitamin B12 deficiency. Methods In this observational study, 200 consecutive consenting metformin-treated T2DM patients, aged 35 and above, attending the diabetic clinic at KATH were recruited. Vitamin B12 deficiency was classified based on the Fedosov age-normalized wellness quotient. Anthropometric measurement was taken as well as blood samples for immunological and biochemical mediators. Peripheral neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Statistical analysis was performed using the R Language for Statistical Computing. Results Using the combined indicator (4cB12), the prevalence of metformin induced vitamin B12 deficiency was 40.5% whilst the prevalence of MNSI-Q and MNSI-PE diabetic neuropathy was 32.5% and 6.5% respectively. Participants with vitamin B12 deficiency had significantly higher levels of IFA, GPA, TNF-α, TC, LDL and albumin compared to those with normal vitamin B12 levels (p < 0.05). Correlation analysis revealed a statistically significant negative association between 4cB12 and the immunological markers [IFA (rs = -0.301, p<0.0001), GPA (rs = -0.244, p = 0.001), TNF-α (rs = -0.242, p = 0.001) and IL-6 (rs = -0.145, p = 0.041)]. Likewise, 4cB12 was negatively associated with TC (rs = -0.203, p = 0.004) and LDL (rs = -0.222, p = 0.002) but positively correlated with HDL (rs = 0.196, p = 0.005). Conclusion Vitamin B12 deficiency and diabetic neuropathy are very high among metformin-treated T2DM patients and it is associated with increased GPA, IFA, TNF-α and cardiometabolic risk factors (higher LDL and TC and lower HDL). Upon verification of these findings in a prospective case-control study, it may be beneficial to include periodic measurement of Vitamin B12 using the more sensitive combined indicators (4cB 12) in the management of patients with T2DM treated with metformin in Ghana.

scholarly journals Profiling Immuno-Metabolic Mediators of Vitamin B12 Deficiency Among Metformin-Treated Type II Diabetes Patients in Ghana

2020 ◽  
Author(s):  
Samuel Sakyi ◽  
Edwin F. Laing ◽  
Richard Mantey ◽  
Alexander Kwarteng ◽  
Eddie-Williams Owiredu ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Neuropathy ◽  
Vitamin B12 ◽  
Intrinsic Factor ◽  
Vitamin B12 Deficiency ◽  
Anthropometric Measurement ◽  
Vitamin B ◽  
Calcium Dependent ◽  
Tnf Α ◽  
B12 Deficiency

Abstract Background: The association between prolong metformin usage and B12 deficiency has been documented. However, the prevalence estimates of metformin-induced vitamin B12 deficiency showed substantial disparity among studies due to varied study definitions of vitamin B12 deficiency. Metformin blocks the calcium dependent absorption of the vitamin B12-Intrinsic Factor complex at the terminal ileum. Lack of intrinsic factor due to the presence of auto-antibodies to parietal cells (IFA) could lead to vitamin B12 deficiency and subsequently cause peripheral neuropathy. We investigated the prevalence of vitamin B12 deficiency using more sensitive, combined markers of vitamin B12 status (4cB12) and the immuno-biochemical mediators of vitamin B12 deficiency.Methods: In this observational study, 200 consecutive metformin-treated T2DM patients, aged 35 and above, attending the diabetic clinic at KATH were recruited. Vitamin B12 deficiency was classified based on the Fedosov age-normalized wellness quotient. Anthropometric measurement was taken as well as blood samples for immunological and biochemical mediators. Peripheral neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Statistical analysis was performed using the R Language for Statistical Computing version 3.6.0. Results: Using the combined indicator (4cB12), the prevalence of metformin induced vitamin B12 deficiency was 40.5% whilst the prevalence of MNSI-Q and MNSI-PE diabetic neuropathy was 67.5% and 93.5% respectively. Participants with vitamin B12 deficiency had significantly higher levels of IFA, GPA, TNF-α, TC, LDL and albumin compared to those with normal vitamin B12 levels (p < 0.05). Correlation analysis revealed a statistically significant negative association between 4cB12 and the immunological markers [AIF (rs= -0.301, p<0.0001), GPA (rs= -0.244, p=0.001), TNF-α (rs= -0.242, p=0.001) and IL-6 (rs= -0.145, p=0.041)]. Likewise, 4cB12 was negatively associated with TC (rs= -0.203, p=0.004) and LDL (rs= -0.222, p=0.002) but positively correlated with HDL (rs= 0.196, p=0.005).Conclusion: Vitamin B12 deficiency and diabetic neuropathy are very high among metformin-treated T2DM patients and it is associated with increased GPA, IFA, TNF-α and cardiometabolic risk factors (higher LDL and TC and lower HDL). It is imperative Ghana include routine measurement of Vitamin B12 deficiency using the more sensitive combined indicators (4cB12), in the management of T2DM patients on metformin.

scholarly journals Funicular Myelosis in a Butcher: It Was the Cream Cans

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Fabian Wolpert ◽  
Krisztina Baráth ◽  
Janis Brakowski ◽  
Roland Renzel ◽  
Michael Linnebank ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Diagnostic Process ◽  
Long Term Effects ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation ◽  
Nutritional Vitamin

Background. Funicular myelosis is a known consequence of exposure to nitrous oxide. Nevertheless, there are only a few clinical trials assessing its long-term effects and there is no literature about the role of nutritional vitamin B12 supplementation in the context of nitrous oxide abuse.Case Descriptions. We diagnosed funicular myelosis in a young butcher, who consumed high amounts of meat regularly. Since the diagnostic process did not reveal any metabolic causes, reinterrogation of the patient uncovered recreational abuse of nitrous oxide out of whipped cream can gas cartridges. After stopping abuse and supplementation of vitamin B12, the patient recovered almost completely.Conclusions. In our case, even high nutritional vitamin B12 uptake could not compensate the noxious effects of nitrous oxide. Since there are emerging reports of increasing misuse, this should be considered in the diagnostic and therapeutic care of patients with nitrous oxide abuse. Furthermore, our case emphasizes that patients with vitamin B12 deficiency should be assessed for nitrous oxide abuse.

scholarly journals Studying The Association Of Metformin Dose With Peripheral Neuropathy In Diabetic Patients At Jordanian Royal Medical Services

2016 ◽  
Vol 12 (6) ◽  
pp. 22
Author(s):  
Wafa'a Jamil Abu Jama'ah ◽  
Motazbellah Fat'hi Alzu'bi ◽  
Alaa Rfeefan Alabbad ◽  
Alaa Mohammed Al Mrayat ◽  
Ola Ahmad Aldmour ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Vitamin B12 ◽  
Diabetic Peripheral Neuropathy ◽  
Vitamin B12 Deficiency ◽  
Medical Services ◽  
Categorical Variables ◽  
Diabetic Patients ◽  
Continuous Variables ◽  
B12 Deficiency ◽  
Royal Medical

The aim of the present study was to study the association of metformin dose with peripheral neuropathy in diabetic patients at Jordanian Royal Medical Services. A retrospective study was conducted to collect data from files of 392 diabetic patients at Jordanian Royal Medical Services. A working sheet was created for each patient that included the following information: gender, age, peripheral neuropathy, vitamin B12 status, metformin use, and metformin dose. Data were analyzed using SPSS version 20. Data were represented as frequencies and percentages for categorical variables such as gender, and vitamin B12 status; means and standard deviations for continuous variables such as age. The relationships between variables were examined using Chi-Square, and One Way Anova. Significance was considered at alpha level <0.05. Study findings showed that the prevalence of diabetic peripheral neuropathy among participants was about 43%. Vitamin B12 deficiency was about 7%. Diabetic peripheral neuropathy was significantly associated with gender (p=0.018). No significant associations were observed between peripheral neuropathy and vitamin B12 or metformin dose. Taken together, the results of the present study showed that treatment with metformin did not lead to vitamin B12 deficiency, although the prevalence of diabetic peripheral neuropathy was relatively high (about 43%).

scholarly journals Infra-Clinical Vitamin B12 Deficiency and Microangiopathic Profile, is this a New Risk Factor in Type 2 Diabetics? Algerian Experience

2018 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Risk Factor ◽  
Peripheral Neuropathy ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Biological Entity ◽  
Diabetic Patients ◽  
Significant Difference ◽  
Emerging Risk ◽  
B12 Deficiency

Introduction: Type 2 diabetes has multifactorial complications, in which hyperhomocysteinemia is an emerging risk factor that may be secondary to various conditions such as vitamin B12 deficiency, which appears oftenly as an asymptomatic setting and less specific in diabetics. Vitamin B12 deficiency definition has been revisited because its level does not reflect the intracellular status of vitamin B12, and an intracellular cofactor must be included systematically. Subclinical deficiency of vitamin B12 has recently been identified as a new clinic-biological entity that can affect micro and macro-angiopathic complications of diabetes indirectly through hyperhomocysteinemia. Materials and methods: 40 diabetic patients were screened for an infra-clinicalvitaminB12 deficiency subdivided into two groups each containing 16 patients, the first group having a deficit and the second having a normal level of vitamin B12. They were compared according to the frequency of micro-antipathy (retinopathy, nephropathy, peripheral neuropathy). Results: No significant difference was found for the different microangiopathic lesions; nevertheless the subclinical deficit seems to be a risk factor for peripheral neuropathy. Conclusion: In this study with a very modest sample. We attempted to approach the link between the borderline deficit of vitamin B12 and micro-angiopathic complications. In these results, even though the risk trend does not seem to be developing, the prospects for more extensive studies, both prospective and fundamental, should be encouraged.

Vitamin B12 Deficiency an Unusual Cause of Fever: A Case Report

2019 ◽  
Vol 4 (02) ◽  
Author(s):  
Shyama . ◽  
P. Kumar ◽  
Surabhi .
Keyword(s):  
Bone Marrow ◽  
Vitamin B12 ◽  
Unusual Case ◽  
Vitamin B12 Deficiency ◽  
Bone Marrow Aspiration ◽  
Microcytic Anemia ◽  
Peripheral Smear ◽  
Erythroid Hyperplasia ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation

Introduction: An unusual case of a 19 year old female, presenting with fever, pallor and hepatosplenomegaly for one month. She had microcytic anemia on peripheral smear examination but her bone marrow aspiration & biopsy revealed a hypercelluar marrow with megaloblastic erythroid hyperplasia. Resolution of fever within 48 hours of Vitamin B12 supplementation, initiated in view of the megaloblastic bone marrow picture & low serumVitamin B12 level, suggests a causal association. Conclusion: Vitamin B12 deficiency seems to be an unusual cause of PUO (Pyrexia of unkown origin) which should be ruled out in every case of PUO.

Chemotherapy-induced peripheral neuropathy (CIPN) and vitamin B12 deficiency

2015 ◽  
Vol 23 (7) ◽  
pp. 1843-1850 ◽  
Author(s):  
Janet M. Schloss ◽  
Maree Colosimo ◽  
Caroline Airey ◽  
Luis Vitetta
Keyword(s):  
Peripheral Neuropathy ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
B12 Deficiency

scholarly journals Management of Peripheral Neuropathy and Cardiovascular Effects in Vitamin B12 Deficiency

2021 ◽  
Vol 10 (5) ◽  
Author(s):  
Nishant Kumar Singh ◽  
Hirni J. Patel ◽  
Mohit Buddhadev ◽  
S P Srinivas Nayak ◽  
Gunosindhu Chakraborthy
Keyword(s):  
Cardiovascular Disease ◽  
Peripheral Neuropathy ◽  
Vitamin B12 ◽  
Peripheral Nerves ◽  
Vitamin B12 Deficiency ◽  
Cardiovascular Effects ◽  
The Elderly ◽  
Vitamin Deficiencies ◽  
B12 Deficiency ◽  
Artery Disease

Peripheral nerves are susceptible to damage by a wide array of toxins, medications, and vitamin deficiencies. Vitamin B12 (VB12) deficiency neuropathy is a rare debilitating disease that affects mostly the elderly. It is important to consider these etiologies when approaching patients with a variety of neuropathic presentations in this review were have included most relevant and latest information on mechanisms causing Peripheral neuropathy in VB12 deficiency. We also have included cardiovascular disorders and their management. Hyperhomocysteinemia has been implicated in endothelial dysfunction and cardiovascular disease. The association of homocysteine (Hcy) and VB12 with cardiovascular risk factors in patients with coronary artery disease (CAD) has also been studied Keywords: Peripheral Neuropathy, Vitamin B12 Deficiency, Cardiovascular Disease and Homocysteine.

Vitamin B12 supplementation did not improve cognition but reduced delirium in demented patients with vitamin B12 deficiency

2008 ◽  
Vol 46 (3) ◽  
pp. 273-282 ◽  
Author(s):  
Timothy Kwok ◽  
Jenny Lee ◽  
Linda Lam ◽  
Jean Woo
Keyword(s):  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation
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