Abstract

VITAMIN B12 DEFICIENCY IN DIABETES MELLITUS: PATHOPHYSIOLOGY, IMPACT AND CLINICAL MANAGEMENT

Mounika Gudavalli*, Rashmi Parasa, Manasa Goriparthi, Navya Venkata Sai Lakshmi Penugonda, Shamini Devarapalli, Pavani K. and Padmalatha Kantamaneni

ABSTRACT

Cobalamin, another name for vitamin B12, is a water-soluble vitamin that is mostly found in foods derived from animals. Vitamin B12 functions as a co-factor for enzymes that are essential for DNA synthesis and neuroprotection at the cellular level. Thus, vitamin B12 deficiency can lead to several clinical consequences that include hematologic abnormalities (e.g., megaloblastic anemia and formation of hyper-segmented neutrophils), and peripheral neuropathy. Patients with type 1 and type 2 Diabetes mellitus have been shown to have a significant prevalence of biochemical and clinical vitamin B12 insufficiency. For optimum hemopoietic, neurocognitive, and cardiovascular function, Vitamin B12 is a necessary micronutrient. There is evidence linking Vitamin B12 insufficiency, which can have major clinical repercussions, to long-term metformin use. As a first-line oral hypoglycaemic medication, metformin is commonly recommended to treat type 2 Diabetes mellitus, which is caused by insulin resistance. Numerous neurological and neurocognitivesymptoms, such as peripheral and automatic neuropathy, delirium, dementia, and axonal demyelination, are linked to Vitamin B12 insufficiency. In diabetic individuals taking metformin for an extended period, these neurological symptoms may be mistakenly perceived as signs of Diabetic neuropathy. This study aims to compile the most recent information onthe pathophysiology, and treatment options of Vitamin B12 insufficiency in DM patients. Thegoal of this synthesis is to improve the quality of life and treatment outcomes for impactedpatients by expanding our knowledge and laying the groundwork for future studies andtherapeutic practice. This study offers a thorough resource in the fields of gastroenterologyand endocrinology.

Keywords: Cobalamin, megaloblastic anemia, hyper-segmented neutrophils, axonal demyelination, diabetes mellitus, vitamin B12, metformin, oral hypoglycaemic, neurocognitive.