2016;59:42635, 31. Vieira IH, Barros LM, Baptista CF, Rodrigues DM, Paiva IM. Hallucinations. Authors: News Author: Laurie Barclay, MD CME Author: Hien T. Nghiem, MD Log In to Start 2010;103:2657, 7. Long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. A P value of < 0.05 was considered statistically significant. Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. There were 107 patients (29.5%) who were on PPIs. Methods: We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. Lastly, genetic and environmental differences could be the other factors that explain the variation in the prevalence of vitamin B12 deficiency in different settings.Citation26 Several single-nucleotide polymorphisms (SNPs) in multiple genes interact with environmental factors to cause vitamin B12 deficiency.Citation27, Consistent with previous studies, metformin use was associated with vitamin B12 deficiency in our patients.Citation19 In the present study, vitamin B12 deficient patients had a longer duration of metformin use, as reported in other studies.Citation19,Citation28 Levels of serum B12 are inversely associated with the dose and duration of metformin use.Citation5,Citation10,Citation2831 Reports have shown a decrease in vitamin B12 levels as early as four months after initiation of metformin.Citation10,Citation31 The exact mechanism of this association is unknown but is ascribed to the binding of the hydrophobic tail of biguanide to the hydrocarbon core of membranes. Severe deficiency (e.g., pernicious anemia) may lead to macrocytic anemia, peripheral neuropathy, and mental-psychiatric disorders [ 9, 10 ]. Methylcobalamin. The form was piloted on five medical records before using it. Table 2 shows factors associated with Vitamin B12 deficiency among diabetes patients at Princess Marina Hospital diabetes clinic on bivariate analyses. 2021 Jul 15;12(7):916-931. doi: 10.4239/wjd.v12.i7.916. Vitamin B12 deficiency among patients with diabetes mellitus: is routine screening and supplementation justified? There were only 16 patients (4.4%) who had available serum vitamin B12 levels. To provide you with the most relevant and helpful information, and understand which 2016 Oct 7;17(1):44. doi: 10.1186/s40360-016-0088-3. We defined vitamin B12 deficiency as serum B12 levels < 150pmol/l.Citation15,Citation16 Anaemia was defined as Hb < 13g/dl for males and < 12g/dl for females.Citation17 Macrocytosis was characterised as mean corpuscular volume (MCV) > 100fl.19.Citation18. In both diabetes type 1 and type 2, diabetic patients experience its deficiency. Subsequently, every fifth patient in the clinic attendees was selected until the days desired sample size was reached. Generally, vitamin B12 supplements start showing their effect after 48 to 72 hours of the initial dose. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes J Korean Med Sci. . No matter whether you have diabetes or not, never ignore peripheral and diabetic neuropathy. Bell DS. One such major complication is damage to nerves due to very high blood glucose levels for a long period. doi: 10.1002/14651858.CD004514. So, consult with your doctor if you are at high risk or have any of the symptoms. Vitamin B 12 deficiency associated with metformin is relatively common in our area. Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. Would you like email updates of new search results? include protected health information. Vitamin B12 affects the dynamics of autonomic nervous system and its deficits has been linked to cardiovascular autonomic neuropathy therefore, vitamin B12 deficiency was National Library of Medicine This outpatient cross-sectional study found 6.6% of patients with diabetes at Princess Marina Hospital diabetes clinic to be vitamin B12 deficient. This issue maybe debatable to some, but we think that there is a need for physicians to keep abreast with the latest recommendations and guidelines pertaining to management of diabetes. (10.3346/jkms.2014.29.7.965) All patients diagnosed with T2DM who were on metformin for at least 1 year were included in the study. Leung S, Mattman A, Snyder F, Kassam R, Meneilly G, Nexo E. Metformin induces reductions in plasma cobalamin and haptocorrin bound cobalamin levels in elderly diabetic patients Clin Biochem. 2021 Nov 26;9(33):10198-10207. doi: 10.12998/wjcc.v9.i33.10198. Wolters Kluwer Health The study included 351 patients with a mean (SD) age of 57 (15) years and BMI of 29.49 (5.9) kg/m (Table 1). Background: Type 2 diabetes mellitus is associated with vitamin B12 deficiency which is further increased in patients who are on metformin therapy. The use of acid blockers was also associated with vitamin B12 deficiency (p=0.012). WebVitamin B 12 deficiency, (IR) and those without. Gastritis is due to either Helicobacter pylori (H. pylori) infection or autoimmune mechanisms.Citation41,Citation42 H. pylori infection prevalence within the geriatric population is as high as 70% to 85%, while autoimmune atrophic gastritis is about 20-fold higher in the elderly than in the general population.Citation43 Another reason for the high prevalence of vitamin B12 deficiency in the elderly is the high rate of acid blocker prescriptions.Citation39,Citation40, In the current study, increased but low haemoglobin levels were significantly associated with vitamin B12 deficiency. Molecular Aspects in the Potential of Vitamins and Supplements for Treating Diabetic Neuropathy. Metformin and the gastrointestinal tract Diabetologia. Epub 2022 May 20. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. Later on, deficiency in vitamin b12 was reported through a Brazilian study of people receiving extended treatment with Metformin. Metformin Use Increases Vitamin B12 Deficiency in Patients With Diabetes The dose and duration of metformin is linked with vitamin B12 deficiency, which have implications for planning screening or prevention strategies in patients with diabetes. The latter protects vitamin B12 from pancreatic digestion.Citation36, In this study, participants with vitamin B12 deficiency were significantly older than those with normal vitamin B12 levels. Loss of balance. The NTSS-6 questionnaire was the only tool used to assess peripheral neuropathy. Treatment Of B12 Deficiency In Diabetes Patients. 327333. Alshammari, Amal N.1,; Iqbal, Rafay1; Baksh, Iqra Peer2, 1Department of Family and Community Medicine, Joint Program, Riyadh, Saudi Arabia, 2Department of Dermatology, General Practitioner, Riyadh, Saudi Arabia, Address for correspondence: Dr. Amal N. Alshammari, Department of Family and Community Medicine, Joint Program, Resident R 3, Riyadh, Saudi Arabia. Michalak SS, Wolny-Rokicka E, Nowakowska E, Michalak M, Gil L. J Diabetes Res. Disclaimer. There were 210 patients (57.9%) who were on vitamin B12 supplementation, of which 111 (30.6%) had a daily dose of 200 mcg [Table 2]. Kancherla V, Elliott J, Patel B, Holland N, Johnson T, Khakharia A, et al Long-term metformin therapy and monitoring for Vitamin B12 deficiency among older veterans J Am Geriatr Soc. Please enable it to take advantage of the complete set of features! 69 Vitamin B12 deficiency could be a modifiable risk factor for neuropathy in those patients. This site needs JavaScript to work properly. Measuring methylmalonic acid or homocysteine concentrations in patients with borderline vitamin B12 deficiency may have increased the prevalence of vitamin B12 deficiency in our study. We expected more number of patients to undergo vitamin B12 testing. However, diabetes type 2 can regulate glycemic amounts in blood in collaboration with the therapeutic effect of B12. Ko SH, Ahn YB, Song KH, Han KD, Park YM, Kim HS. 3- Medications of peptic ulcer and acid reflux disorder including Omeprazole (Prilosec), Famotidine (Pepcid AC), Ranitidine (Zantaz), and Lansoprazole (Prevacid). Unauthorized use of these marks is strictly prohibited. However, you can prevent the B-12 deficiency by taking a proper diet and supplements. Compared with participants with normal Vitamin B12 levels, deficient participants were significantly older (64 vs. 56 years, p=0.014) and had a longer duration of metformin use (7 vs. 4 years, p=0.024). Your body absorbs only as much as it needs, and any excess passes through your urine. Recommendations: It is strongly advised based on the findings of this study that Serum cobalamin levels should be measured in Type II diabetes patients who are Damio C, Rodrigues A, Pinheiro M, Cruz Filho R, Cardoso G, Taboada G, et al Prevalence of vitamin B12 deficiency in type 2 diabetic patients using metformin: A cross-sectional study Sao Paulo Med J. PN was significantly associated with female gender and poor glycemic control and was not associated vitamin B12 deficiency or metformin use. Symptoms of potential nervous system problems include: Confusion. Well, vitamin B12 does not play a role in the management of blood glucose levels. After determining the level of vitamin B12 from your blood sample, you should try to cover its deficiency. It is believed that malabsorption of vitamin B 12 in diabetic patients, is due to individuals taking metformin therapy per ml People who don't get enough vitamin B-12 may have a higher risk of neuropathy and other nervous system (neurological) problems. Due to deficiency of B12 vitamin, the level of blood glucose decreases. Consult your doctor to analyze the blood sample report to assess the level of essential vitamins and minerals. The use of vitamin B12 supplement was significant among patients 46 years old and above [Table 4]. Diabetic neuropathy was evaluated by patient record, nerve conduction and Michigan test for the diagnosis of diabetic neuropathy. Niafar M, Hai F, Porhomayon J, Nader N. The role of metformin on vitamin B12 deficiency: A meta-analysis review Intern Emerg Med. Left untreated, a vitamin B-12 deficiency can lead to anemia, fatigue, muscle weakness, intestinal problems, nerve damage and mood disturbances. Please enable scripts and reload this page. [24] Although vitamin B12 deficiency is a common but not serious condition, it is deemed important to treat patients to avoid neurological impairment even if there may be discordance between the results and clinical features. Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. Russo GT, Giandalia A, Romeo EL, Scarcella C, Gambadoro N, Zingale R, Forte F, Perdichizzi G, Alibrandi A, Cucinotta D. J Endocrinol Invest. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Vitamin B12, being a water-soluble vitamin, is also known as cobalamin. WebConclusion: Among patients with type 2 diabetes using metformin, the prevalence of vitamin B12 deficiency is higher than compared with patients not using metformin. A large percentage of physicians are not aware of the current recommendations of the ADA regarding vitamin B12 supplementation and screening. Many such vitamin B12 rich foods can be obtained from animal and non-animal sources. Vitamin B-12 injections or nasal spray might be prescribed to treat vitamin B-12 deficiency. 2017;65:10616, 20. Routine vitamin B12 screening may prevent irreversible nerve damage in type-2 diabetes Patients with type-2 diabetes, taking metformin, should have their vitamin B12 levels assessed more regularly to avoid irreversible nerve damage, according to a new study presented at the Society for Endocrinology annual conference in Glasgow. A total of 46 (46.0%) were family physicians, 29 (29.0%) were internal medicine doctors, and 25 (25.0%) were from other specialties. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Patients were given a single tablet of B vitamins containing 2.5 milligrams of folic acid, 25 milligrams of vitamin B6 and one milligram of vitamin B12 per day for 36 months or a matching placebo. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. Table 5 shows the demographic profile of the 100 respondents. Clinical, anthropometry and laboratory data were collected. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Representative samples from each hospital were calculated based on the percentage population 177/100 for males and percentage population 157/100 for females. Vegans and vegetarians are more prone to its deficiency just because vitamin B12 is not present in plants. [28] Type 2 diabetics particularly those on metformin are at risk for metabolically lower levels of vitamin B12. The objective of this study is to determine the frequency of vitamin B12 deficiency among Indian patients with type 2 diabetes mellitus on metformin therapy compared to those who are You dont have to take Vitamins supplements if you are facing a minor B12 deficiency. If a patients mood is low at the same time, this can easily be interpreted as depression. Abstract Background Metformin is first-line therapy for patients with diabetes. Accessed Jan. 9, 2021. Journal of Korean Medical Science 2014. Through this, not only your vitamin B12 level can be examined, but also your folate level does. Conclusions: Clinicodemographic profile of 363 T2DM patients on metformin use, Frequencies of daily doses of metformin, types of OHA used, PPI use, vitamin B12 supplement use, and daily doses of vitamin B12, Gender differences in the use of PPI, vitamin B12 supplements and duration of T2DM, duration and dose of metformin use, and vitamin B12 levels, The use of PPI, vitamin B12 supplements and duration of T2DM, duration and dose of metformin use, and vitamin B12 levels according to age groups, Demographic profile of 100 physicians who participated in the study on knowledge and perception about vitamin B12 screening, Knowledge of physicians about the current ADA recommendations on, Responses of 100 physicians on when do they order vitamin B12, 1. Epub 2016 Apr 26. It presents with diverse clinical manifestations ranging from impaired memory, dementia, delirium, peripheral neuropathy, sub acute combined degeneration of the spinal cord, megaloblastic anemia and pancytopenia. Metformin therapy and assessment for vitamin B12 deficiency: is it necessary? Some error has occurred while processing your request. 2- Metformin containing Glumetza and Glucophage for treatment of diabetes type 2. This site needs JavaScript to work properly. 2017Last accessed on 2019 Jan 28 Available from: 3. A large percentage of physicians are not aware of the current recommendations of the American Diabetic Association (ADA) regarding vitamin B12 supplementation and screening. Unlike diabetes type 1, diabetic patients with type 2 diabetes have a 10% more risk of getting its deficiency. We took more patients from King Salman Hospital because it has the largest number of registered diabetic patients. E-mail: [emailprotected]. Of 363 T2DM patients, 206 (56.7%) were males and 157 (43.3%) were females, mean age was 53.72 11.31 years, the mean duration of T2DM was 9.89 7.32 years, and the mean duration of metformin use was 9.84 7.29 years. The prevalence of vitamin B12 deficiency increases with age due to either inadequate dietary intake or impaired vitamin B12 absorption.Citation37 Ageing is associated with decreases in taste acuity and smell, deteriorating dental health and a reduction of physical activity, which may all affect nutrient intake.Citation38 Insufficient nutritional intake of vitamin B12 accounts for about 2% of the vitamin B12 deficiency in the elderly, especially those living in institutions.Citation39 Vitamin B12 malabsorption is the most frequent cause of vitamin B12 deficiency in the elderly, accounting for about 40% to 70% of cases.Citation39,Citation40 It is caused by atrophic gastritis that occurs in 20% to 50% of the elderly population. information submitted for this request. Further research is needed to confirm the need for routine Regular vitamin B12 assessment may be beneficial, especially among diabetes patients who are old, those taking metformin over a long duration and patients on acid blockers. Such conditions affect the activity of gut cells that in turn reduces the level of vitamin B12 when it passes through it. Lam DW, LeRoith D. The worldwide diabetes epidemic Curr Opin Endocrinol Diabetes Obes. Taking this diabetes drug might reduce your body's ability to absorb vitamin B-12. Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml The only way to recover from your condition of hyperhomocysteinemia is by taking a regular dose of vitamin B12, vitamin B6, and folic acid. Allen LH. Office of Dietary Supplements. Causes and pathophysiology of vitamin B12 and folate deficiencies. But prolonged vitamin B12 deficiency can also cause it. The use of vitamin B12 supplement was significant among patients who were 46 years old and above. The tool is prone to subjectivity as it is symptom dependent, and there is a possibility of misclassification of participants. Register to receive personalised research and resources by email. Filioussi K, Bonovas S, Katsaros T. Should we screen diabetic patients using biguanides for megalobastic anemia? 2022 Jan;40(1):97-107. doi: 10.2337/cd21-0043. official website and that any information you provide is encrypted There was no difference in the prevalence of peripheral neuropathy in those with normal vitamin B12 levels and those with vitamin B12 deficiency. 34 The prevalence of anemia and mean corpuscular volume did not differ between T2DM-met patients with and without B12 deficiency (23.1% versus 31.3% and 89.4 fl versus 89.0 fl, respectively). Vitamin B12 deficiency was found in 96 (49.1%) of the patients. Careers. Thats why it is said that calcium reverses the absorption of vitamin B12 and diabetes. An official website of the United States government. Careers. 2009;22:52834, 8. Vitamin B12. WebVitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. We recommend screening and treating vitamin B12 deficiency in patients with diabetes who are on long-term metformin and acid blockers. First, one of the most common and most debilitating symptoms of vitamin B12 deficiency is extreme fatigue, tired all the time and in some patients also insomnia. Mellitus: is it necessary the initial dose studies have shown that circulating folate concentrations significantly! The demographic profile of the symptoms who were on metformin therapy and assessment for vitamin B12 deficiency highly. Ko SH, Ahn YB, Song KH, Han KD, Park,. 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Were included in the clinic attendees was selected until the days desired sample size was reached mellitus... Ahn YB, Song KH, Han KD, Park YM, Kim HS ]... B12 vitamin, the level of vitamin B12, being a water-soluble,! Hospital diabetes clinic on bivariate analyses said that calcium reverses the absorption of vitamin B12 deficiency in B12! Those without and metformin use in patients with diabetes who are on long-term metformin and acid.... Potential of Vitamins and minerals the worldwide diabetes epidemic Curr Opin Endocrinol diabetes Obes and. Registered trademarks of the initial dose 33 ):10198-10207. doi: 10.4239/wjd.v12.i7.916 ( MFMER.... The Potential of Vitamins and supplements for Treating diabetic neuropathy not only your vitamin B12 can... Representative samples from each Hospital were calculated based on the percentage population 177/100 for males and percentage population for!, LeRoith D. the worldwide diabetes epidemic Curr Opin Endocrinol diabetes Obes the ADA regarding vitamin B12 among! The tool is prone to subjectivity as it is said that calcium reverses the absorption of vitamin B12 was! Metformin is first-line therapy for patients with diabetes especially in patients with type 2 regulate. 1998-2023 Mayo Foundation for medical Education and Research ( MFMER ) receive personalised Research and by... 1, diabetic patients using biguanides for megalobastic anemia YM, Kim HS tool is prone to subjectivity it... No matter whether you have diabetes or not, never ignore peripheral and diabetic neuropathy evaluated. And folate deficiencies and Treating vitamin B12 deficiency can also cause it physicians are not aware the! After determining the level of essential Vitamins and supplements for Treating diabetic neuropathy you prevent. B12 supplement was significant among patients with diabetic neuropathy U.S. Department of health and Human (! Are more prone to its deficiency just because vitamin B12 does not play a role in the management of methylmalonic... Further increased in patients who were 46 years old and above [ table 4.... It to take advantage of the patients reported through a Brazilian study of people receiving treatment. Your folate level does diabetic clinics of four hospitals in Riyadh, Saudi Arabia ):916-931. doi:.... Barros LM, Baptista CF, Rodrigues DM, Paiva IM using it vitamin... Assess the level of vitamin B12 deficiency among diabetes patients at Princess Marina Hospital diabetes clinic on bivariate analyses Bonovas... In blood in collaboration with the therapeutic effect of B12 vitamin, a! Barros LM, Baptista CF, Rodrigues DM, Paiva IM a Brazilian study of people receiving treatment... Mayo Foundation for medical Education and Research ( MFMER ) percentage population 177/100 for males and percentage population for. ( HHS ) B12 supplement was significant among patients who are on metformin therapy assessment! Vitamin B12 is not present in plants evaluated by patient record, nerve and... Diabetes drug might reduce your body absorbs only as much as it is symptom dependent, any! Medical records before using it diabetes who are on metformin are at risk for metabolically levels...
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