Expert Perspectives on Prescription Practices and Management Strategies for Neuropathy and Vitamin B12 Deficiency in Indian Settings

Objective: To gather expert opinion regarding prescription practices and management strategies for neuropathy and vitamin B12 deficiency with a special focus on methylcobalamin among clinicians in Indian settings. Methodology: This cross-sectional study utilized a 24-item, multiple-response questionnaire to gather expert opinion from specialists in managing neuropathy and vitamin B12 deficiency. The survey encompassed questions about current prescription practices, clinical observations, preferences, and experiences related to managing neuropathy and vitamin B12 deficiency in patients in routine settings. Results: The survey included 81 experts, with more than half (62.96%) of clinicians identifying diabetes as a significant confounding factor for neuropathy in patients. As indicated by 46% and 44% of the clinicians, an appropriate diet for nutrition and maintaining glycemic levels helps to overcome the progression of neuropathy. A significant proportion of experts (60.49%) reported that 26% to 50% of patients with neuropathy have vitamin B12 deficiency. Additionally, 73% of clinicians noted that diabetes mellitus is a common co-morbid condition with vitamin B12 deficiency. In patients with neuropathy complications, 74% of clinicians preferred benfotiamine alongside vitamin B12. As stated by 44% of clinicians, besides those patients with neuropathy, elderly patients are also recommended with methylcobalamin 1500 mcg. About 43% of clinicians suggested a 12-week duration for prescribing a combination of benfotiamine and methylcobalamin for patients with neuropathy. Additionally, more than half (54.32%) of clinicians favored prescribing a combination of methylcobalamin 1500 mcg, pregabalin 75 mg, and nortriptyline 10 mg tablets to patients with chronic neuropathic pain. Conclusion: The survey highlights diabetes as a significant factor in neuropathy management, emphasizing the importance of nutrition and glycemic control. A high prevalence of vitamin B12 deficiency is noted among diabetic patients with neuropathy, leading to recommendations for benfotiamine and methylcobalamin supplementation. Additionally, the use of combination therapy for chronic neuropathic pain demonstrates a comprehensive approach to improving patient outcomes.