# The Assessment of the Autonomic Polyneuropathy Through Sudoscan and Vitamin B12 in Patients with Type 2 Diabetes Mellitus and High Cardiovascular Risk or Established Cardiovascular Disease

## TL;DR

This study examines how vitamin B12 levels and Sudoscan testing relate to nerve and heart issues in type 2 diabetes patients.

## Contribution

The study evaluates the practicality of Sudoscan and vitamin B12 as tools for assessing autonomic neuropathy in high-risk diabetes patients.

## Key findings

- No significant correlation was found between vitamin B12 levels and diabetic peripheral neuropathy severity.
- Sudoscan showed limited diagnostic value for autonomic dysfunction when used alone.
- Vitamin B12 was associated with cardiovascular risk when assessed with Sudoscan.

## Abstract

Background: Diabetes Mellitus (DM) is frequently associated with diabetic peripheral neuropathy (DPN) and cardiovascular diseases (CVD). The aim of this study is to assess the relationship between DPN symptoms, vitamin B12 level, and autonomic neuropathy in DM patients with high and very high CV risk or established CVD. Material and Methods: A cross-sectional analysis of 164 patients from the Outpatient DM Department of Suceava County Hospital from September 2025 was performed. The clinical, paraclinical, and demographic data were collected, including Toronto Clinical Neuropathy Score (TCNS), Sudoscan, Orthostatic Hypotension (OH), and B12 level. Results: In total, 65.9% of patients had DPN; the mean HbA1c was 8.22% ± 1.74. No significant correlation was obtained between autonomic neuropathy (Sudoscan) and DPN severity (p = 0.163) or between vitamin B12 and DPN (p = 0.6). Vitamin B12 was associated with CV risk assessed with Sudosan (p = 0.04). OH had limited diagnostic significance for autonomic dysfunction. Conclusions: No strong link was detected between B12 levels and DPN; thus, it cannot be considered a predictive marker. Objective DPN screening remains essential. Sudoscan is practical and non-invasive in assessing autonomic neuropathy, but only when combined with TCNS may it increase the DPN screening and risk stratification in high-CV-risk populations with DM.