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Evidence also suggests that B12 deficiency can cause inflammation and damage to blood vessels, as well as oxidative stress, which combined can interrupt normal blood flow to the feet (Spence, 2016)

Jiang N, Li W, Jiang S, Xie M, Liu R

Metformin was most effective in women with a history of gestational diabetes, in people between the ages of 25 and 44, and in people with obesity who had a body mass index of 35 or higher

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Future research should focus on large-scale, well-controlled randomized trials with standardized dosing protocols, clearly defined deficiency thresholds, and long-term follow-up to strengthen the evidence base and guide clinical practice