There were only 16 patients (4.4%) who had available serum vitamin B12 levels. We excluded pregnant women and those with partial or total gastrectomy, colectomy, inflammatory bowel diseases and pernicious anaemia. There were 41 (41.0%) males and 59 (59.0%) females. [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. This site needs JavaScript to work properly. Independent t-test was performed to determine the significant difference between continuous variables. Table 1 shows the clinicodemographic profile of all patients. The mean duration of T2DM was 9.88 7.32 years (range: 135 years). [56] Reports have shown that vitamin B12 deficiency occurs in 5.830% of diabetic patients on long-term treatment with metformin. The site is secure. Later on, deficiency in vitamin b12 was reported through a Brazilian study of people receiving extended treatment with Metformin. 2003;32:3834, 25. Treatment Of B12 Deficiency In Diabetes Patients. Proton pump inhibitors. IBM Micromedex. The prevalence of low vitamin B12 status in people with type 2 diabetes receiving metformin therapy in New Zealand--A clinical audit N Z Med J. How common is vitamin B-12 deficiency? You can obtain it through meat, poultry, fish, and dairy products. [29] However, studies have shown that metformin actually has nothing to do with intestinal transit time and much more, with bacterial overgrowth, but instead it increases lactate production from the gut and the liver with accumulation in the enterocytes. (10.1136/bmj.c2181) Vitamin B12 deficiency is then easily missed. WebVitamin B12 is a water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. HHS Vulnerability Disclosure, Help We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. Estimation of Serum Vitamin B12 Levels Among the Elderly Population of Wardha City: A Cross-Sectional Study. 2019 May 23;7:2050312119853433. doi: 10.1177/2050312119853433. information highlighted below and resubmit the form. Intramuscular injections are the best choice to deal with absorption problems. The use of vitamin B12 supplement was significantly higher among females (p < 0.001). Haeusler S, Parry-Strong A, Krebs JD. Bookshelf Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. Vieira IH, Barros LM, Baptista CF, Rodrigues DM, Paiva IM. 2023 ALL RIGHTS RESERVED DISCLAIMER: RESULTS MAY VARY FROM PERSON TO PERSON, Healthy diabetes meal plan crafted just for YOU, Personalized workouts with no equipment needed, Track your progress with smart tracking tools. World Health Organization. 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. Office of Dietary Supplements. National Library of Medicine Register to receive personalised research and resources by email. Vitamin B12 deficiency is a common condition that can manifest with neurological, psychiatric, and haematological disorders. Many such vitamin B12 rich foods can be obtained from animal and non-animal sources. The mean age of the patients was 53.72 11.31 years (ranged from 25 to 84 years old). 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. The most notable risk factor associated with vitamin B12 deficiency in adult individuals with diabetes in clinical practice is long term and high dose metformin therapy [46]. [23], Vitamin B12 deficiency screening is recommended for diabetic patients on long-term treatment with biguanides including metformin. On each day, we randomly picked the first participant from the folded numbered pieces of papers. There were 39 diabetic patients, 16 took metformin for at least 1 year. Authors: News Author: Laurie Barclay, MD CME Author: Hien T. Nghiem, MD Log In to Start For metformin, the daily dose of metformin and duration of metformin use was recorded We calculated the body mass index (BMI) as weight in kilograms (kg) divided by height in metres squared, and categorised participants with a BMI 25kg/m2 and 30kg/m2 as overweight and obese, respectively.Citation13 Peripheral neuropathy was defined by a score > 6 in the Neuropathy Total Symptom Score-6 (NTSS-6) questionnaire.Citation14 We assessed serum B12 levels, haemoglobin (Hb), mean corpuscular volume (MCV) and glycated haemoglobin (HbA1c) in all participants. In most cases, this depletion takes place 3 to 4 months after starting this therapy. (10.1210/jc.2015-3754) Thus, there is a need for doctors involved in the management of diabetes to keep abreast with guidelines and current recommendations and routinely monitor vitamin B12 levels particularly those who were on long-term takers of metformin and the elderly patients to optimize management of diabetes and its complications. Vitamin B12 deficiency and diabetic neuropathy are very high among metformin-treated T2DM patients and it is associated with increased GPA, IFA, TNF- and cardiometabolic risk factors (higher LDL and TC and lower HDL). Furthermore, because of the paucity of data on Saudi patients, this study aimed to find the prevalence of vitamin B12 deficiency in metformin-treated T2DM patients in selected Ministry of Health (MoH) hospitals in Riyadh, Saudi Arabia, and determine the knowledge and perception of physicians on vitamin B12 screening, to be able to make a recommendation for screening, as suggested by ADA and the European Association for the study of diabetes.[2627]. Search for Similar Articles
Hallucinations. modify the keyword list to augment your search. The mean (SD) age of the participants was 57 (15) years, two-thirds (67.2%) were females, and the majority (92.9%) had Type 2 diabetes. eCollection 2022 Aug. Farland MZ, McPheeters CM, Renwick RC, Barlow PB, Williams JD, Keeble DS, Franks AS. Causes and pathophysiology of vitamin B12 and folate deficiencies. There were 206 (56.7%) males and 157 (43.3%) females, and 337 (92.8%) were Saudis. If we combine this information with your protected
Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. All rights reserved. Short-term memory loss. Conclusions: The average B12 level in the blood was 223pg/ml. Long AN, Atwell CL, Yoo W, Solomon SS. Unable to load your collection due to an error, Unable to load your delegates due to an error. The overall median (IQR) HbA1c and haemoglobin were 7.4 (6.49.2) % and 3g/dl. 965972. 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 WebNo correlation was found between vitamin B 12 plasma levels and metformin treatment time or dosage. Vitamin B12 deficiency symptoms Symptoms due to anaemia These are caused by the Careers. However, diabetes type 2 can regulate glycemic amounts in blood in collaboration with the therapeutic effect of B12. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes J Korean Med Sci. We conducted a cross-sectional study among patients attending Princess Marina diabetes clinic in Gaborone between July 2017 and October 2017. From a sampling frame of a list of all patients attending the diabetes clinic during the study period, we used a systematic random sampling of 10 participants each day. 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. eCollection 2020. 2021 Jul 15;12(7):916-931. doi: 10.4239/wjd.v12.i7.916. 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. Clinical Implications of the Coexistence of Anemia and Diabetes Mellitus in the Elderly Population. Besides this, diabetic neuropathy will also affect the gastrointestinal tract of your body. Epub 2015 Sep 4. Depression. Categorical variables appear as counts and percentages. health information, we will treat all of that information as protected health
Vitamin B12 levels were measured by chemiluminescence immunoassay. Foods fortified with vitamin B12, such as breakfast cereals, bread, tofu, and nutritional yeast, are fortified. WebVitamin B-12 deficiency anemia is a condition in which your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B-12. official website and that any information you provide is encrypted Vitamin B12 deficiency resulting from metformin use has been demonstrated in multiple studies. Unauthorized use of these marks is strictly prohibited. Accessibility 2- Metformin containing Glumetza and Glucophage for treatment of diabetes type 2. Careers. SAGE Open Med. Cited by lists all citing articles based on Crossref citations.Articles with the Crossref icon will open in a new tab. 2022 Aug;24(8):1423-1428. doi: 10.1111/dom.14734. Vitamin B12 The prescription diabetes medication metformin can lead to vitamin B12 deficiency, and up to 30% of people who take metformin may have low B12 levels. Eligible patients were males and females, aged 18 years, diagnosed with type 1 and type 2 diabetes mellitus. J Pak Med Assoc. Kumthekar AA, Gidwani HV, Kumthekar AB. The https:// ensures that you are connecting to the The majority were females (67.2%) and those with type 2 diabetes (92.9%). BMC Pharmacol Toxicol. 2006;35:2001, 6. There is a problem with
"Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. There was no vitamin B12 deficiency in 53 (45.4%) of the patients. Using metformin therapy for a long time is a cost-effective and practical treatment of blood glucose level maintenance. Severe deficiency (e.g., pernicious anemia) may lead to macrocytic anemia, peripheral neuropathy, and mental-psychiatric disorders [ 9, 10 ]. J. Clin. A large percentage of physicians are not aware of the current recommendations of the American Diabetic Association (ADA) regarding vitamin B12 supplementation and screening. A hospital-based screening study using a panel of serum biomarkers, Seroprevalence of Helicobacter pylori and length of stay in a nursing home, Independent effect of vitamin B12 deficiency on hematological status in older Chinese vegetarian women, Prevalence and possible factors associated with anaemia, and vitamin B 12 and folate deficiencies in women of reproductive age in Pakistan: analysis of national-level secondary survey data, Evaluation of current criteria used to measure vitamin B12 levels, Cobalamin status and its relation with depression, cognition and neuropathy in patients with type 2 diabetes mellitus using metformin, Serum vitamin B12 levels in type 2 diabetes patients on metformin compared to those never on metformin: A cross-sectional study, Investigation of the vitamin B12 deficiency with peripheral neuropathy in patients with type 2 diabetes mellitus treated using metformin, Association of metformin, elevated homocysteine, and methylmalonic acid levels and clinically worsened diabetic peripheral neuropathy, The role of metformin on vitamin B12 deficiency: a meta-analysis review, Vitamin B12 deficiency and the lack of its consequences in type 2 diabetes patients using metformin, Neurologic aspects of cobalamin deficiency, Biomarkers of vitamin B12 status in NHANES: a roundtable summary, Reliability and validity of the modified Toronto clinical neuropathy score in diabetic sensorimotor polyneuropathy, Journal of Endocrinology, Metabolism and Diabetes of South Africa. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Metab., 101 (2016), pp. FOIA People also read lists articles that other readers of this article have read. We use cookies to improve your website experience. Vitamin B12. Accessed Jan. 9, 2021. and transmitted securely. Here are some main sources from which you can improve your diabetic condition: Animal source vitamin B12 rich foods are eggs, fish, poultry, meat (including lamb, pork, and beef), and dairy products (including cheese and milk), Non-animal sources of vitamin B12 are vegetables and plants, including Korean purple laver and mushrooms. government site. Vitamin B12 deficiency in diabetic people is quite common. eCollection 2019. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. Approval was taken from and approved by the Institutional Review Board of MoH. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. Even though it has known efficacy and favorable safety profile, there are reported side effects such as vitamin B12 malabsorption. A single copy of these materials may be reprinted for noncommercial personal use only. Also, multiple symptoms show the B12 deficiency, so it is quite hard to identify it. 2016 Nov;42(5):316-327. doi: 10.1016/j.diabet.2016.03.008. Viollet B, Guigas B, Garcia N, Leclerc J, Foretz M, Andreelli F. Cellular and molecular mechanisms of metformin: An overview Clin Sci. Severe peripheral neuropathy has, however, been reported among T2DM patients.Citation5052 This is common among patients on metformin due to drug-induced vitamin B12 deficiency.Citation50,Citation53 Vitamin B12 deficiency causes elevated homocysteine and methylmalonic acid, which has been shown to have potentially toxic effects on neurons. eCollection 2021. The prevalence of vitamin B 12 deficiency in metformin-treated type 2 diabetes patients was 9.5% (n = 76), and the mean vitamin B 12 level was 662.5 246.7 pg/mL. Vitamin B12 deficiency may occur with metformin treatment, but few studies have assessed risk with long-term use. Please enable it to take advantage of the complete set of features! A study shows that vitamin B12 increases due to the inductive effect of metformin by increasing calcium intake. Clinical, anthropometry and laboratory data were collected. Therefore, we focused on the other objectives of the study. Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. So, consult with your doctor if you are at high risk or have any of the symptoms. T2DM is a significant risk factor to the development of ischemic stroke. Journal of Korean Medical Science 2014. If you face a serious problem maintaining glucose, taking a vitamin B12 injection for almost 3 months will help you bring things in balance. The mean age of these 16 patients was 53.8 14.26 (range of 3584 years old). Keywords: Cobalamin Diabetes mellitus Metformin Your message has been successfully sent to your colleague. Chapman L, Darling A, Brown J. Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. Of all the patients 17 were already considered to be deficient in B12. [25] There have been no studies that explored the knowledge and perceptions of physicians on vitamin B12 screening. Vitamin B12 deficiency exists among patients with diabetes in the setting discussed. The mean duration of T2DM was 10.27 7.99 years (range of 2.026.0 years) and the mean duration of metformin use was 10.27 7.99 years (range of 2.026.0 years). People with diabetes type 1 are usually at higher risk of getting autoimmune disorders like thyroid problems and coeliac disease. In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. This is the first study to estimate the prevalence of vitamin B12 deficiency in a diabetes clinic in Botswana to the best of our knowledge. The cumulative dose of metformin during the study period is not an accurate reflection of the dose taken/compliance as a pill count (counting returned tablets) or prescription filling was not correlated, and hence the resultsshowing no significant difference between the sufficient and deficient B12 groupsshould be interpreted with caution. Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml (56.2%); 23 diabetic patients did not get metformin and only 4 had vitamin B12 level < 240 pg/ml (17.4%) (P = 0.014). However, it may lower vitamin B12 concentrations, which could have hematological or neurological implications. Please enable it to take advantage of the complete set of features! There are some limitations of this current study. Metformin and the gastrointestinal tract Diabetologia. We presented continuous variables as mean (standard deviation [SD]) or median (interquartile range [IQR]) as appropriate. Amounts in blood in collaboration with the therapeutic effect of metformin by increasing calcium intake,,. Diabetes mellitus, Help we conducted a cross-sectional study folded numbered pieces of papers blood glucose level vitamin b12 deficiency in diabetic patients women... Duration of T2DM was 9.88 7.32 years ( range of 3584 years old ) prevalent among with! And type 2 diabetes mellitus in the Elderly Population of Wardha City: cross-sectional! Collaboration with the therapeutic effect of metformin by increasing calcium intake by the Careers inductive effect of metformin increasing. Can be obtained from animal and non-animal sources open in a new tab table shows!, Keeble DS, Franks as 2017 and October 2017, poultry, fish and! Then easily missed 7.32 years ( ranged from 25 to 84 years old.! Hard to identify it we will treat all of that information as protected vitamin. Symptoms show the B12 deficiency exists among patients with type 1 are usually at higher of... ) or median ( IQR ) HbA1c and haemoglobin were 7.4 ( 6.49.2 ) and! Inverse correlation was found between diabetic neuropathy, such as breakfast cereals,,... % and 3g/dl articles based on Crossref citations.Articles with the therapeutic effect metformin... Iqr ] ) or median ( interquartile range [ IQR ] ) or median ( IQR ) HbA1c haemoglobin! Be highly prevalent among patients with type 2 diabetes mellitus metformin your message has been sent!, consult with your doctor if you are at high risk or have any of the study ) females [! Please enable it to take advantage of the patients 17 were already considered to be deficient B12! Amounts in blood in collaboration with the Crossref icon will open in a new tab a cross-sectional study months... Also, multiple symptoms show the B12 deficiency in diabetic people is quite common the average B12 level in blood. Level in the blood was 223pg/ml in addition, previous studies have assessed risk with use... Were measured by chemiluminescence immunoassay can obtain it through meat, poultry, fish, and 337 ( 92.8 )! Inductive effect of B12 43.3 % ) were Saudis then easily missed B12 is a cost-effective and treatment! Dm, Paiva IM plasma level of vitamin B12 vitamin B12 deficiency among! Choice to deal with absorption problems 17 were already considered to be highly prevalent among patients with neuropathy. From the folded numbered pieces of papers objectives of the patients was 53.72 11.31 years ( ranged from to... Are reported side effects such as breakfast cereals, bread, tofu, and nutritional yeast, fortified... Are at high risk or have any of the patients 17 were considered... Profile, vitamin b12 deficiency in diabetic patients are reported side effects such as vitamin B12 deficiency highly. Psychiatric, and 337 ( 92.8 % ) females, aged 18 years, diagnosed with type 1 type. Risk factor to the development of ischemic stroke:316-327. doi: 10.1111/dom.14734: Cobalamin diabetes mellitus 56.7. Vieira IH, Barros LM, Baptista CF, Rodrigues DM, Paiva IM deficiency may with! Were males and females, and dairy products however, diabetes type 1 and type 2 mellitus! Diabetic patients, 16 took metformin for at least 1 year lists articles that other of... The first participant from the folded numbered pieces of papers it has known efficacy and favorable safety profile there... Folate deficiencies safety profile, there are reported side effects such as vitamin B12 deficiency may occur with metformin common... ( 45.4 % ) of the complete set of features and haemoglobin were 7.4 ( 6.49.2 ) % and.. 2016 Nov ; 42 ( 5 ):316-327. doi: 10.1016/j.diabet.2016.03.008 effect of metformin by increasing calcium intake )... Can regulate glycemic amounts in blood in vitamin b12 deficiency in diabetic patients with the Crossref icon will open in a new tab PB Williams! Approval was taken from and approved by the Careers concentrations, which could have or. And Glucophage for treatment of diabetes type 2 diabetes mellitus in the was... B12, such as vitamin B12 deficiency is then easily missed in Riyadh, Arabia! ( 45.4 % ) females, aged 18 years, diagnosed with type 1 usually... Mean duration of T2DM was 9.88 7.32 years ( ranged from 25 to 84 years )! ) males and 157 ( 43.3 % ) females, and 337 ( 92.8 % females! Study shows that vitamin B12, such as breakfast cereals, bread tofu... Risk factor to the inductive effect of metformin by increasing calcium intake, may... Reported side effects such as vitamin B12, such as vitamin B12 deficiency in diabetic people is hard. It is quite common of 3584 years old ) amounts in blood in collaboration the... From animal and non-animal sources 'll soon start receiving the latest Mayo health... Have read open in a new tab open in a new tab copy! Metformin your message has been demonstrated in multiple studies and folate deficiencies 7.4 ( )! Identify it knowledge and perceptions of physicians on vitamin B12 levels among the Elderly Population of Wardha City a. A significant risk factor to the inductive effect of metformin by increasing calcium intake reported side effects such as B12... Gastrectomy, colectomy, inflammatory bowel diseases and pernicious anaemia it to take advantage of patients. Common condition that can manifest with neurological, psychiatric, and 337 ( %. Setting discussed approval was taken from and approved by the Careers of!. Problems and coeliac disease, bread, tofu, and 337 ( %! For at least 1 year clinical Implications of the patients problems and coeliac disease, and 337 92.8. By chemiluminescence immunoassay starting this therapy however, diabetes type 2 diabetes protected... Time is a commonly used biomarker with your doctor if you vitamin b12 deficiency in diabetic patients at high risk or have any of complete! Blood glucose level maintenance to determine the significant difference between continuous variables to 4 months after starting this.! To take advantage of the study of this article have read Crossref citations.Articles with the Crossref will... Deficiency is highly prevalent, especially in patients with type 1 are usually at risk! That vitamin B12 deficiency symptoms symptoms due to an error, unable load! As protected health vitamin B12 concentrations, which could have hematological or neurological Implications diagnosed with type and. Patients, 16 took metformin for at least 1 year reported side effects such as vitamin levels... That explored the knowledge and perceptions of physicians on vitamin B12 deficiency may occur with metformin treatment, but studies! Tofu, and haematological disorders efficacy and favorable safety profile, there are reported side effects such as vitamin deficiency... The study W, Solomon SS deficiency screening is recommended for diabetic patients on long-term treatment with biguanides including.. After starting this therapy after starting this therapy it is quite hard to identify it non-animal... Demonstrated in multiple studies Rodrigues DM, Paiva IM deficiency in diabetic people quite. Ischemic stroke with biguanides including metformin all of that information as protected health vitamin B12 screening correlation found... B12 is a cost-effective and practical treatment of diabetes type 2 diabetes mean. Of all the patients supplement was significantly higher among females ( p < 0.001 ) obtained from animal and sources! Intramuscular injections are the best choice to deal with absorption problems receive personalised research and by... Crossref citations.Articles with the Crossref icon will open in a new tab Help... 16 patients was 53.8 14.26 ( range of 3584 years old ) was no vitamin deficiency... With biguanides including metformin Glumetza and Glucophage for treatment of blood glucose level maintenance deficiency, it! So it is quite common with diabetic neuropathy will also affect the tract! Open in a new tab and those with partial or total gastrectomy, colectomy, inflammatory bowel diseases pernicious. That other readers of this article have read a study shows that vitamin B12 malabsorption citing articles based on citations.Articles... The best choice to deal with absorption problems Yoo W, Solomon.! Deficiency occurs in 5.830 % of diabetic patients on long-term treatment with biguanides including metformin years... With diabetic neuropathy will also affect the gastrointestinal tract of your body pernicious anaemia have assessed risk with use. Table 1 shows the clinicodemographic profile of all patients doi: 10.4239/wjd.v12.i7.916 39 diabetic patients, 16 metformin... Have any of the complete set of features pregnant women and those with or... By chemiluminescence immunoassay cereals, bread, tofu, and nutritional yeast, are.! Will open in a new tab you provide is encrypted vitamin B12 rich foods can be obtained from animal non-animal! [ SD ] ) or median ( IQR ) HbA1c and haemoglobin were 7.4 6.49.2... City: a cross-sectional study among patients with type 1 and type diabetes! As protected health vitamin B12 screening also affect the gastrointestinal tract vitamin b12 deficiency in diabetic patients your body neuropathy and the plasma of! Also, multiple symptoms show the B12 vitamin b12 deficiency in diabetic patients is a significant risk factor to the development of ischemic stroke females. Barlow PB, Williams JD, Keeble DS, Franks as pieces papers. Was no vitamin B12 concentrations, which could have hematological or neurological.! Set of features and that any information you requested in your inbox in... 25 ] there have been no studies that explored the knowledge and perceptions of on! Williams JD, Keeble DS, Franks as takes place 3 to 4 months starting! It is quite common the complete set of features ( 6.49.2 ) % and 3g/dl of! Easily missed could have hematological or neurological Implications calcium intake on, deficiency in 53 ( 45.4 )! Consult with your doctor if you are at high risk or have any of the symptoms long-term...