Compared with participants with normal Vitamin B12 levels, deficient participants were older (64 vs. 56 years, p=0.014), had longer metformin use duration (7 vs. 4 years, p=0.024), had low haemoglobin (13.4 vs. 12.8; p=0.038) and used acid blockers (p=0.012). The prevalence of vitamin B12 deficiency in patients with type 2 diabetes: a cross-sectional study, Association of biochemical B12 deficiency with metformin therapy and vitamin B12 supplements: the national health and nutrition examination survey, 19992006. We took more patients from King Salman Hospital because it has the largest number of registered diabetic patients. Vitamin B12 affects the dynamics of autonomic nervous system and its deficits has been linked to cardiovascular autonomic neuropathy therefore, vitamin B12 deficiency was Abstract Background Metformin is first-line therapy for patients with diabetes. The first thing you should keep in mind while treating vitamin B12 deficiency is to act upon a doctors prescription. If you face a serious problem maintaining glucose, taking a vitamin B12 injection for almost 3 months will help you bring things in balance. WebGeneral physical symptoms of vitamin B12 deficiency can include: Feeling very tired or weak. Careers. The use of vitamin B12 supplement was significantly higher among females (p < 0.001). Would you like email updates of new search results? A single copy of these materials may be reprinted for noncommercial personal use only. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. https://naturalmedicines.therapeuticresearch.com. In the human body, the small intestine is the part where absorption of Vitamin B12 takes place. Biochemical B 12 deficiency was defined as serum B 12 concentrations 148 pmol/L and borderline deficiency was defined as >148 to 221 pmol/L. Long AN, Atwell CL, Yoo W, Solomon SS. Review/update the https://www.wolterskluwercdi.com/facts-comparisons-online/. Also, multiple symptoms show the B12 deficiency, so it is quite hard to identify it. Avoid drinking goat milk because its low in folate and vitamin B12. Metformin associated B12 deficiency J Assoc Physicians India. The prevalence rate of serum B12 deficiency and peripheral neuropathy was obtained as the total number of existing cases per total number of participants in the study, respectively. In addition, female patients had higher levels of vitamin B12 compared to men (coefficient: 49.1; CI 95%: 2.3-95). The .gov means its official. Of 99,400 diabetic patients registered in the four above-mentioned hospitals, 85,442 patients (85.95%) were from King Salman Hospital, 8,624 (8.67%) were from King Saud Medical City, 3,780 (3.80%) were from Imam Abdulrahman Alfaisal Hospital and 1,554 (1.56%) were from Prince Mohammad bin Abdulaziz Hospital. Never take a supplement or injection at your own decision. Association between metformin and vitamin B. Metformin: Sex/Gender Differences in Its Uses and Effects-Narrative Review. 2022 Aug;24(8):1423-1428. doi: 10.1111/dom.14734. There are some limitations of this current study. The patients on metformin had statistically lower There were 206 (56.7%) males and 157 (43.3%) females, and 337 (92.8%) were Saudis. We presented continuous variables as mean (standard deviation [SD]) or median (interquartile range [IQR]) as appropriate. The prevalence of vitamin B12 deficiency in the present study is comparable to reports from Brazil and Korea but lower than previously described in African countries.Citation8,Citation1921 For instance, the prevalence of vitamin B12 deficiency in South Africa and Uganda was (28%) and (10.7%), respectively.Citation20,Citation21 The variations in diets across communities may partly explain the differences in the prevalence of vitamin B12 deficiency across studies. The https:// ensures that you are connecting to the We assessed vitamin B12 status using serum vitamin B12 levels. However, people who follow a vegetarian or vegan diet might be prone to deficiency because plant foods don't contain vitamin B-12. 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. To assess the knowledge and practice of physicians about screening for vitamin B12 deficiency in metformin-treated diabetic patients, a self-administered questionnaire was distributed to all physicians conducting diabetic clinics in above-mentioned hospitals. Vieira IH, Barros LM, Baptista CF, Rodrigues DM, Paiva IM. It has been suggested that healthy people can have low levels of vitamin B12, and much more vitamin B12 deficiency commonly occurs in around 6% of elderly patients aged 60 years with prevalence increasing with age. 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 There were only 16 patients (4.4%) who had available serum vitamin B12 levels. Vitamin B12 level was lower in type 2 diabetic patients on metformin compared to those on other oral anti-diabetic drugs, but without significant deficiency. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. Liu et al. We did not exclude patients with chronic kidney disease (especially those with eGFR < 50) and those on salicylates. Approval was taken from and approved by the Institutional Review Board of MoH. Table 1: Baseline characteristics of patients with diabetes at Princess Marina hospital diabetes clinic, between July 2017 and October 2017 (n=351). A large percentage of physicians are not aware of the current recommendations of the ADA regarding vitamin B12 supplementation and screening. Vitamin B12 deficiency among adult diabetic patients in Uganda: relation to glycaemic control and haemoglobin concentration, Food consumption changes in Botswana since 1966, Influence of duration and dose of metformin on cobalamin deficiency in type 2 diabetes patients using metformin, Association of vitamin B12 and metformin in type II diabetes patients in Bahrain, An update on vitamin B12-related gene polymorphisms and B12 status, B-vitamins, genotype and disease causality: symposium on genetic polymorphisms and disease risk, Vitamin B 12 levels in patients with type 2 diabetes mellitus on metformin, Vitamin-B12 status of patients on long-term metformin therapy, Risk factors of vitamin B12 deficiency in patients receiving metformin, Effects of short-term treatment with metformin on serum concentrations of homocysteine, folate and vitamin B12 in type 2 diabetes mellitus: a randomised, placebo-controlled trial, Increased vitamin B12 requirement associated with chronic acid suppression therapy, Long-term use of proton pump inhibitors and vitamin B12 status in elderly individuals, A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and risk of vitamin B 12 deficiency in older adults, Vitamin B12 deficiency associated with histamine2-receptor antagonists and a proton-pump inhibitor, Intrinsic factor secretion and cobalamin absorption: physiology and pathophysiology in the gastrointestinal tract, Vitamin B12 deficiency in the elderly: is it worth screening, Vitamin B12 (cobalamin) deficiency in elderly patients, Helicobacter pylori eradication has the potential to prevent gastric cancer: a state-of-the-art critique, Prevalence of H. pylori infection and atrophic gastritis among symptomatic and dyspeptic adults in Kazakhstan. 2017Last accessed on 2019 Jan 28 Available from: 3. Type 2 Of all the patients 17 were already considered to be deficient in B12. 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. official website and that any information you provide is encrypted Higher doses of metformin and male sex were factors related to lower levels of vitamin B12. 2010;103:2657, 7. [2] The prevalence of diabetes in Saudi Arabia alone has increased to reach 7 million cases. Similar findings have been previously reported in different settings.Citation20,Citation4749 In the current study, NTSS-6 was used to assess neuropathy. Also, add a good amount of green leafy vegetables to your diet. On the contrary, this study also highlighted that a large number of our physicians are not aware or updated with the current recommendations of ADA regarding vitamin B12 supplementation and vitamin B12 screening for T2DM patients on metformin. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. It said: A paired t-test showed that in group A [the group given B12], patients with vitamin B12 These can include dementia, disorientation, neurological damage, gait disturbance and anemia. Metformin-induced vitamin B12 deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy in the patient with diabetes. Vitamin B12. 2010;43:75960, 10. Regulate your bodys diabetes level by regulating the amount of vitamin B12. The duration of metformin use is dependent on the patients history and thus subject to recall bias. Diabetes Care 2012. It depicts that vitamin B12 absorption is a calcium-dependent process. 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. 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. 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). Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. This outpatient cross-sectional study found 6.6% of patients with diabetes at Princess Marina Hospital diabetes clinic to be vitamin B12 deficient. While in anemia, the number of healthy red blood cells to carry out oxygen depletes. Clipboard, Search History, and several other advanced features are temporarily unavailable. So, consult with your doctor if you are at high risk or have any of the symptoms. Methods In this retrospective study, we recruited 412 We used a researcher-administered questionnaire to obtain information on patients age, sex, HIV status, diabetes type and diabetes duration. Adults with type 2 diabetes and low levels of vitamin B12 could be more likely to experience cardiovascular autonomic neuropathy (CAN), according to new findings. Diabetic neuropathy is not associated with homocysteine, folate, vitamin B12 levels, and MTHFR C677T mutation in type 2 diabetic outpatients taking metformin. 2014;29:96572, 13. de Jager J, Kooy A, Lehert P, Wulffele M, van der Kolk J, Bets D, et al Long-term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: Randomised placebo-controlled trial BMJ. Additional data, including demographic characteristics were collected. Please try after some time. Disclaimer. Please try again soon. Snchez H, Masferrer D, Lera L, Arancibia E, Angel B, Albala C. Vitamin B12 deficiency associated with high doses of metformin in older people diabetic Nutr Hosp. McCreight LJ, Bailey CJ, Pearson ER. MeSH Registered in England & Wales No. In short, the long-term deficiency of vitamin B12 causes serious symptoms like depression, delusion, difficulty in walking, loss of mobility, seizures, and dementia. Viollet B, Guigas B, Garcia N, Leclerc J, Foretz M, Andreelli F. Cellular and molecular mechanisms of metformin: An overview Clin Sci. Accessibility 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. diabetes mellitus; diabetic neuropathies; malabsorption; metformin; prediabetic state; syndromes; vitamin B12. [4] Both American and European guidelines recommend metformin as the first-line agent for the pharmacological management of T2DM. 2015 Dec;41(6):550-5. doi: 10.1016/j.encep.2015.07.004. The mean serum vitamin B12 level of all 16 patients was 558.46 318.01 pg/mL (range of 1741288 pg/mL). J. Clin. Register to receive personalised research and resources by email. Chapman L, Darling A, Brown J. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). eCollection 2019. You can control blood glucose level in your body by increasing intake of vitamin B12. One such major complication is damage to nerves due to very high blood glucose levels for a long period. Nutr Cancer. WebLong-term low vitamin B12 levels caused by pernicious anemia can affect your nervous system. Besides this, diabetic neuropathy will also affect the gastrointestinal tract of your body. These symptoms are pain and numbness in the arms, legs, hands, and feet. The mean daily dose of metformin was 984.85 320.96 mg (range: 5002000 mg). information is beneficial, we may combine your email and website usage information with A skilled professional, Dr. Barnett holds certification from the American Board of Internal Medicine with a special focus on endocrinology, diabetes, and metabolism. Facts & Comparisons eAnswers. 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]. 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. This review article offers a current perspective on the physiological roles of vitamin B12, proposed pathophysiological mechanisms of vitamin B12 deficiency, screening for vitamin B12 deficiency and vitamin B12 supplementation among patients with diabetes mellitus. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The most commonly used oral hypoglycemic agent was gliclizide only in 138 (38.4%) of patients. -Chronic treatment should be done with an oral preparation in patients with normal intestinal absorption. Table 1 shows the clinicodemographic profile of all patients. There were 210 patients (57.9%) who were on vitamin B12 supplementation, of which 111 (30.6%) had a daily dose of 200 mcg. Allen LH. T2DM is a significant risk factor to the development of ischemic stroke. Please enable scripts and reload this page. A total of 6 of the 16 patients (37.5%) used PPI, and 11 (68.8%) had Vitamin B12 supplementation. The tool is prone to subjectivity as it is symptom dependent, and there is a possibility of misclassification of participants. 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