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Vitamin E studies A 2012 study of 132,000+ individuals in China showed that a high level of consumption of vitamin E either from diet or vitamin supplements lowered the risk of liver cancer

Standard medical dosing for confirmed deficiency typically involves an initial loading phase followed by maintenance

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Furthermore, recent studies point to possible protection against macular degeneration and heart disease by lowering homocysteine levels

This is a stark contrast to the typically slow improvement of polyneuropathy in POEMS, and could imply that at least part of the underlying mechanism causing neuropathy in POEMS may be related to vitamin B6 deficiency, and that an evaluation of vitamin levels in POEMS may be currently underappreciated

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