![]() Vitamin B 12 or cobalamin is a water-soluble vitamin that plays a fundamental role in DNA synthesis, optimal hemopoiesis, and neuronal and vascular functions. Several studies have shown vitamin B 12 deficiency in diabetes. Most importantly, our previous studies suggested that vitamin B 12 deficiency could be an independent risk factor for DR. However, to date, only a few studies have evaluated the possible role of nutritional factors in the development of DR. Recently, we reported a high prevalence of multiple subclinical micronutrient deficiencies, dietary inadequacies (along with hyperhomocysteinemia) in apparently healthy adults (30–70 years old), particularly B vitamins, including vitamin B 12. Studies suggested that patients with diabetes are at higher risk for deficiency of micronutrients. A cross-sectional study conducted in the United Kingdom (UK) showed that DR was much more prevalent in people of Afro-Caribbean descent and South Asians compared to Caucasians, and they were at higher risk for sight-threatening complications. Studies have reported ethnic differences in the prevalence and severity of DR even after controlling for systemic risk factors. Age, duration of diabetes, lower body mass index, higher fasting plasma glucose, and higher HbA1c levels have been identified as the risk factors most strongly associated with the development of DR. Multiple factors are likely to be involved in the onset and progression of DR. According to the World Health Organization (WHO), almost 32 million Indians have DR, and this number is estimated to increase to almost 80 million by 2030, the highest number in any country. The prevalence of PDR is 50% in type 1 and 15% in type 2 diabetics with 25 years of disease. ![]() In the advanced stage of DR known as proliferative DR (PDR), neovascularization is seen that is fragile and leaky causing further damage to the retina. The early stages of DR (non-proliferative DR, NPDR) are characterized by the presence of microaneurysms, dot and blot hemorrhages, cotton wool spots, and venous abnormalities, depriving blood supply to areas of the retina. ![]() DR is a common complication in both types of diabetes, and the symptoms include blurred vision, floaters, difficulty seeing colors, and even total loss of vision. Persistent hyperglycemia disrupts the microvasculature and neuronal functioning in the retina leading to vision loss. ![]() DR leads to vision loss through two main mechanisms: leakage of fluid in the macula and growth of new blood vessels and mechanical damage to the retina. Diabetic retinopathy (DR) is the most common microvascular complication of diabetes, and is the leading cause of blindness and visual impairment affecting one-third of people with diabetes worldwide. Poor glycemic control and long disease duration are significant risk factors of the microvascular and macrovascular complications that cause most of the morbidity and mortality associated with diabetes. With the increase in the incidence of diabetes, its complications have also increased accordingly, impairing quality of life and causing socioeconomic burdens. Approximately 463 million adults globally live with diabetes, and by 2045, this will rise to 700 million International Diabetes Federation. Prolonged exposure to chronic hyperglycemia in diabetes can lead to various short- and long-term complications. Diabetes has become one of the most challenging health problems worldwide.
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