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The Right B12 for Fighting Diabetic Neuropathy

Neuropathy is a common complication of type 2 diabetes. It appears in 10 to 18 percent of those initially diagnosed with the condition, but can also show symptoms in those with prediabetes, too.

The nerve damage that causes the loss of sensation or tingling in the fingers, toes, legs, and feet is typically the beginning of the problem; if the condition worsens, muscles and nerves continue to deteriorate throughout the body.

This clinical study found that a one-year supplementation of 1,000 mcg of vitamin B12 improved quality of life, nerve response, and reduced pain.

One thing to note is that the type of vitamin B12 chosen in this clinical study was methylcobalamin, the active form actually used by the body. The advantage of starting out with a supplemental methylcobalamin is that it doesn’t require any conversion by the liver in order to be beneficial. Some people have a difficult time converting the cyanocobalamin form of B12, which is the type frequently found in many supplements.


Didangelos T, Karlafti E, Kotzakioulafi E, Margariti E, Giannoulaki P, Batanis G, Tesfaye S, Kantartzis K. Vitamin B12 Supplementation in Diabetic Neuropathy: A 1-Year, Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients. 2021 Jan 27;13(2):395. doi: 10.3390/nu13020395. PMID: 33513879; PMCID: PMC7912007.

Aim: To investigate the effect of normalizing vitamin B12 (B12) levels with oral B12 (methylcobalamin) 1000 μg/day for one year in patients with diabetic neuropathy (DN).

Patients and methods: In this prospective, double-blind, placebo-controlled trial, 90 patients with type 2 diabetes on metformin for at least four years and both peripheral and autonomic DN were randomized to an active treatment group (n = 44) receiving B12 and a control group (n = 46) receiving a placebo. All patients had B12 levels less than 400 pmol/L. Subjects underwent measurements of sural nerve conduction velocity (SNCV), sural nerve action potential (amplitude) (SNAP), and vibration perception threshold (VPT), and they performed cardiovascular autonomic reflex tests (CARTs: mean circular resultant (MCR), Valsalva test, postural index, and orthostatic hypotension). Sudomotor function was assessed with the SUDOSCAN that measures electrochemical skin conductance in hands and feet (ESCH and ESCF, respectively). We also used the Michigan Neuropathy Screening Instrument Questionnaire and Examination (MNSIQ and MNSIE, respectively) and questionnaires to evaluate quality of life (QoL) and level of pain (pain score).

Results: B12 levels increased from 232.0 ± 71.8 at baseline to 776.7 ± 242.3 pmol/L at follow-up, p < 0.0001, in the active group but not in the control group. VPT, MNSIQ, QoL, pain score, SNCV, SNAP, and ESCF significantly improved in the active group (p < 0.001, p = 0.002, p < 0.0001, p < 0.000, p < 0.0001, p < 0.0001, and p = 0.014, respectively), whereas CARTS and MNSIE improved but not significantly. MCR, MNSIQ, SNCV, SNAP, and pain score significantly deteriorated in the control group (p = 0.025, p = 0.017, p = 0.045, p < 0.0001, and p < 0.0001, respectively).

Conclusions: The treatment of patients with DN with 1 mg of oral methylcobalamin for twelve months increased plasma B12 levels and improved all neurophysiological parameters, sudomotor function, pain score, and QoL, but it did not improve CARTS and MNSIE.

Here is the link to the complete study: Vitamin B12 Supplementation in Diabetic Neuropathy: A 1-Year, Randomized, Double-Blind, Placebo-Controlled Trial

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Terry is happy to provide his opinion on diet and nutrition, supplements and lifestyle choices. This information is for educational purposes only. It is not meant to replace the advice of your physician and is not to be considered medical advice, diagnosis or treatment. Should you have any concerns please contact your physician directly.
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