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From a laboratory medicine perspective, the Association for Clinical Biochemistry and Laboratory Medicine (ACB) and the Royal College of Pathologists (RCPath) advise that: HbA1c may be unreliable in the presence of haemolytic anaemia, haemoglobinopathies, or nutritional deficiencies affecting red cell biology and the direction of distortion may be high or low Clinicians should document any known haematological conditions when requesting HbA1c, so laboratory staff can flag potential inaccuracies Serum B12 testing should be considered in patients on long-term metformin who are symptomatic or have risk factors for deficiency, in line with MHRA and NICE advice Alternative tests fasting plasma glucose, OGTT, or interim use of fructosamine/glycated albumin should be considered when HbA1c reliability is in doubt The NHS website (nhs.uk) provides patient-facing information on the HbA1c test and factors that can affect its accuracy, which patients may find a useful starting point

Regular follow-up appointments and blood tests will help ensure that patients maintain optimal B12 levels and reduce the risk of deficiency-related health issues

Hence it is found in milk products and meat

clinical and genetic aspects

One of the primary reactions of methylcobalamin in the body is to convert homocysteine to methionine high homocysteine levels are undesirable and known to be an indicator of heart disease and stroke risk due to the fact free homocysteine in the blood causes sclerosis of the arteries, putting strain on the vascular system and the heart

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