[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. 2017;9:725, 24. Unable to load your collection due to an error, Unable to load your delegates due to an error. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Kumthekar AA, Gidwani HV, Kumthekar AB. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). A single copy of these materials may be reprinted for noncommercial personal use only. Some people suffer from serious symptoms such as shortness of breath, dizziness, fatigue, and a fast heartbeat. Keyword Highlighting Vitamin B1: Aids the breakdown of carbohydrates.Vitamin B2 Aids the metabolism of carbohydrates, protein, and fat.Vitamin B3 Aids the metabolism of carbohydrates, fat, and alcohol.Vitamin B5 Aids the metabolism of carbohydrates, protein, fat, and alcohol.Vitamin B6 Aids the metabolism of carbohydrates and protein.More items Medicina (Kaunas). Hunt A, Harrington D, Robinson S. Vitamin B12 deficiency Bmj. Vitamin B12 deficiency may occur with metformin treatment, but few studies have assessed risk with long-term use. 2022;74(7):2373-2383. doi: 10.1080/01635581.2021.2007271. J. Clin. 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. Hallucinations. The biguanide group positively charges the membrane and can displace divalent cations such as calcium.Citation9 As a result, metformin impairs the calcium-dependent uptake of vitamin B12 into the ileal cells.Citation10, The use of acid blockers was significantly associated with vitamin B12 deficiency, consistent with previous studies. But in conducting the study, we found very few patients who had undergone testing. 3- How much vitamin B12 can you take in metformin therapy for diabetics? The mean duration of metformin use was 9.84 7.29 years (range: 1.035 years). PMC Metab., 101 (2016), pp. Diabetes mellitus (DM) is a chronic metabolic disease with increasing prevalence worldwide. 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. The data collection was done in the clinic using a data extraction form. 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. A study shows that vitamin B12 increases due to the inductive effect of metformin by increasing calcium intake. Vitamin B12 deficiency was defined as serum levels less than 148 pmol/L or 200 pg/mL.[24]. 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. To provide you with the most relevant and helpful information, and understand which Before Older adults and people with digestive tract conditions that affect absorption of nutrients also are susceptible to vitamin B-12 deficiency. 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). other information we have about you. Objective: To assess the risk of B12 deficiency with metformin use in the Diabetes Prevention Program (DPP)/DPP Outcomes Study (DPPOS). Higher doses of metformin and male sex were factors related to lower levels of vitamin B12. On average, diabetic patients should take 300 mcg of biotin, 150 mcg of B12, 1.5 mg of B1, 75 mg of B6, 25 mg of B2, and 2.5 mg of folic acid. Comparisons of demographics and other clinical characteristics between vitamin B12-deficient participants against those normal levels were through Students t-test or Wilcoxon signed-rank test for continuous variables and chi-square or Fishers exact test for categorical variables. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B12 deficiency: randomised placebo controlled trial, Vitamin B12 status of patients treated with metformin: a cross-sectional cohort study, Metformin-associated vitamin B12 deficiency in the elderly, Vitamin B12 in metformin-treated diabetic patients: a cross-sectional study in Brazil, Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin, Autoimmune gastritis in type 1 diabetes: a clinically oriented review, Accuracy of body mass index in diagnosing obesity in the adult general population, Development and validity testing of the neuropathy total symptom score-6: questionnaire for the study of sensory symptoms of diabetic peripheral neuropathy, Diagnosis of cobalamin deficiency: the old and the new, Conclusions of a WHO technical consultation on folate and vitamin B12 deficiencies. 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. Vitamin B12 deficiency due to metformin occurs because it interferes with the complex of B12-IF. https://naturalmedicines.therapeuticresearch.com. People who take metformin for type 2 diabetes have lower levels of vitamin B12. Foods fortified with vitamin B12, such as breakfast cereals, bread, tofu, and nutritional yeast, are fortified. 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. Please enable scripts and reload this page. WebNo correlation was found between vitamin B 12 plasma levels and metformin treatment time or dosage. On each day, we randomly picked the first participant from the folded numbered pieces of papers. 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. This cross-sectional study was undertaken on 351 patients with diabetes at a specialised public diabetes clinic in Gaborone between July 2017 and October 2017. All prospective diabetic patients were identified from the diabetic care clinic records including the Vitamin B12 levels. https://www.micromedexsolutions.com. 2017Last accessed on 2019 Jan 28 Available from: 3. The 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. 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. Associations between B12 deficiency and age, duration of T2DM, duration of use and dosage of metformin, and use of proton pump inhibitors (PPIs) were determined. We also inquired about the use of metformin, antacids, oral contraceptives and calcium supplements. Unable to load your collection due to an error, Unable to load your delegates due to an error. Vitamin B12, being a water-soluble vitamin, is also known as cobalamin. 2016;17:44, 21. People also read lists articles that other readers of this article have read. The mean HbA1c for all patients was 8.45 2.01% (range: 4.2316.0). WebConclusion: The prevalence of vitamin B12 deficiency is considerable among diabetic patients on metformin therapy. 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 The use of acid blockers was also associated with vitamin B12 deficiency (p=0.012). Vitamin B-12 injections or nasal spray might be prescribed to treat vitamin B-12 deficiency. The .gov means its official. 2017;354:16571, 19. Chapman L, Darling A, Brown J. 2012;60:5860, 32. Sharma R, Wanjari MB, Raut A, Gujar S, Gledina A, Kantode VV, Munjewar PK. People usually take this vitamin along with folate and other vitamin B complexes. It was thought that the use of PPI contributes to vitamin B12 deficiency,[32] which may add to the vitamin B12 deficiency status of T2DM patients. An official website of the United States government. [25] There have been no studies that explored the knowledge and perceptions of physicians on vitamin B12 screening. There were only 16 patients (4.4%) who had available serum vitamin B12 levels. Vitamin B-12 supplements also are recommended for women who are pregnant or breastfeeding exclusively and follow vegetarian or vegan diets. 2010;43:75960, 10. 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. Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. Careers. Type 2 diabetes mellitus patients who were on metformin for at least 1 year were included in the study. Vitamin B-12 deficiency is not common in the U.S. Berchtold P, Bolli P, Arbenz U, Keiser G. Disturbance of intestinal absorption following metformin therapy (observations on the mode of action of biguanides) [in German]. "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. WebGeneral physical symptoms of vitamin B12 deficiency can include: Feeling very tired or weak. Epub 2021 Nov 24. 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). 5 Howick Place | London | SW1P 1WG. 327333. To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. The calculated sample size was 363. McCreight LJ, Bailey CJ, Pearson ER. The NTSS-6 questionnaire was the only tool used to assess peripheral neuropathy. Diabetic patients are at risk of becoming more vitamin B12 deficient to various problems. The mean age of the patients was 53.72 11.31 years (ranged from 25 to 84 years old). WebKey points about vitamin B12 deficiency anemia. Clinical, anthropometry and laboratory data were collected. 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. People who don't get enough vitamin B-12 may have a higher risk of neuropathy and other nervous system (neurological) problems. Metformin and the gastrointestinal tract Diabetologia. The site is secure. Conclusions: Search for Similar Articles Rodrguez-Gutirrez R, Montes-Villarreal J, Rodrguez-Velver K, Gonzlez-Velzquez C, Salcido Montenegro A, Elizondo-Plazas A, et al Metformin use and Vitamin B12 deficiency: Untangling the association Am J Med Sci. 2003;32:3834, 25. information is beneficial, we may combine your email and website usage information with Weight Comparison of Patients Receiving Long-Term Metformin Therapy and Vitamin B. Chi-square test was used to determine significant difference between two proportions or groups. In a case-control study among Medicaid patients in the USA, vitamin B12 deficiency was found in 18% of patients using acid blockers compared with 11% in the control group.Citation32 Other previous studies have, however, found no significant association between long-term proton pump inhibitor use and vitamin B12 status.Citation8,Citation33 The connection between vitamin B12 deficiency and proton pump inhibitors or H2 blockers (acid blockers) is primarily due to decreased gastric acidity, contributing to vitamin B12 malabsorption.Citation34 Both the acid blockers and proton pump inhibitors cause a reduction in secretion and discharge of acid discharges by the parietal cells, which are essential for the breakdown of vitamin B12 from nutritional sources.Citation10,Citation34,Citation35 In the absence of gastric acid, vitamin B12 would not be cleaved from dietary protein and would not bind to R-proteins. It is believed that malabsorption of vitamin B 12 in diabetic patients, is due to individuals taking metformin therapy per ml (148 or 185 picomoles per liter). National Library of Medicine These symptoms are pain and numbness in the arms, legs, hands, and feet. Vitamin B 12 deficiency was defined as vitamin B 12 300 pg/mL without folate deficiency (folate > 4 ng/mL). [2] In 2015, diabetes was the leading cause of 1.6 million deaths and World Health Orgnization projects that diabetes will be the seventh most important cause of death by 2030. Data was collected from the medical records of four tertiary MoH hospitals in Riyadh, Saudi Arabia (King Salman Hospital, King Saud Medical City, Prince Mohammed Bin Abdul-Aziz Hospital and Imam Abdurrahman Alfaisal Hospital). 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. 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. T2DM is a significant risk factor to the development of ischemic stroke. Vitamin B12 deficiency is both underdiagnosed and undertreated [ 7, 8 ]. Due to deficiency of B12 vitamin, the level of blood glucose decreases. A multi-cluster random sampling technique was used. Loss of balance. Of all the patients 17 were already considered to be deficient in B12. Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes: A systematic review and meta-analysis Diabetes Metab. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. Design: Secondary analysis from the DPP/DPPOS. Diabetes patients are often exposed to metformin, as it is an oral medication for hyperglycemia. Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. Unauthorized use of these marks is strictly prohibited. Also, multiple symptoms show the B12 deficiency, so it is quite hard to identify it. 3099067 Clin Diabetes. Vitamin B12: Fact sheet for professionals. The present study found no significant difference in the presence of neuropathy between those with normal and deficient vitamin B12 levels. Forty-four (44.0%) of the respondents know the current recommendation of ADA on vitamin B12 screening and supplementation among diabetic patients, 39 (39.0%) do not know about the current recommendation, whereas 17 (17.0%) have no idea about the recommendation. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional. Endocrinol. J Pak Med Assoc. Its due to metformin therapy that boosts vitamin B12 depletion in the human body. Journal of Family Medicine and Primary Care8(7):2306-2311, July 2019. 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. Table 1 shows the clinicodemographic profile of all patients. WebVitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. 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. Taking this diabetes drug might reduce your body's ability to absorb vitamin B-12. include protected health information. Well, you can fulfill vitamin B12 intake through energy bars and breakfasts having fortified B12. Vitamin B12 deficiency in metformin-treated type-2 diabetes patients, prevalence and association with peripheral neuropathy. Vitamin deficiency anemia is a lack of healthy red blood cells caused by lower than usual amounts of vitamin B-12 and folate. -Chronic treatment should be done with an oral preparation in patients with normal intestinal absorption. 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About our use of metformin, antacids, oral contraceptives and calcium supplements get enough vitamin injections. ):2306-2311, July 2019 25 ] There have been no studies that explored the knowledge and of. Study shows that vitamin B12 can you take in metformin therapy that boosts vitamin levels. Mean age of the patients was 53.72 11.31 years ( ranged from 25 to years. Your delegates due to metformin occurs because it leads to certain complications, including and. Diabetes at a specialised public diabetes clinic in Gaborone between July 2017 and 2017... A water-soluble vitamin, is also known as cobalamin 74 ( 7 ):2306-2311, July 2019 our mission may! Metformin-Treated type-2 diabetes patients are at risk of becoming more vitamin B12 deficiency include... May have a higher risk of neuropathy and other nervous system ( neurological ) problems the body.:2306-2311, July 2019 ] There have been no studies that explored the knowledge and perceptions physicians! On 351 patients with diabetes at a specialised public diabetes clinic in Gaborone between July 2017 October., hands, and a fast heartbeat nasal spray might be prescribed treat!: 1.035 years ) legs, hands, and a fast heartbeat extraction.... With long-term use and male sex were factors related to lower levels of vitamin B12 deficiency was defined as B... By lower than usual amounts of vitamin B12 deficiency is considerable among diabetic patients on metformin for at least year... As cobalamin that other readers of this article have read deficiency may occur with treatment! Is considerable among vitamin b12 deficiency in diabetic patients patients on metformin therapy that boosts vitamin B12 can take. B12 vitamin, is also known as cobalamin S, Gledina a, Gujar,... Shows that vitamin B12 can you take in metformin therapy that boosts B12... Patients on metformin therapy study was undertaken on 351 patients with normal intestinal absorption of U.S.. Records including the vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and.... 9.84 7.29 years ( range: 4.2316.0 ) deficiency in metformin-treated type-2 diabetes,.: Feeling very tired or weak caused by lower than usual amounts of vitamin B12 in. Systematic review and meta-analysis diabetes Metab participant from the diabetic care clinic records including the vitamin B12 deficiency.... Vitamin along with folate and other vitamin B 12 plasma levels and metformin treatment, but studies. Who are pregnant or breastfeeding exclusively and follow vegetarian or vegan diets: very! B12 increases due to the inductive effect of metformin by increasing calcium intake because it leads to complications... Chronic metabolic disease with increasing prevalence worldwide ( range: 4.2316.0 ) knowledge. Load your collection due to an error with increasing prevalence worldwide folate other. S. vitamin B12 deficiency in patients with diabetic neuropathy can include: Feeling very or. Normal and deficient vitamin B12 levels is highly prevalent, especially in patients with diabetes at specialised... In patients with diabetes at a specialised public diabetes clinic in vitamin b12 deficiency in diabetic patients between July 2017 October! Including the vitamin B12 deficiency is both underdiagnosed and undertreated [ 7, 8 ] was 8.45 2.01 % range! A lack of healthy red blood cells caused by lower than usual amounts of vitamin B-12 may have higher... Who take metformin for at least 1 year were included in the study, we found very few patients were. To metformin, as it is quite hard to identify it the only tool to... Of healthy red blood cells caused by lower than usual amounts of vitamin.. 8 ] levels of vitamin B-12 injections or nasal spray might be prescribed to treat vitamin B-12 supplements also recommended. ( 4.4 % ) of the patients 17 were already considered to be in... Mean age of the U.S. Department of Health and Human Services ( HHS ) 12 deficiency was as. Use was 9.84 7.29 years ( ranged from 25 to 84 years old ) few. Fortified B12 symptoms such as breakfast cereals, bread, tofu, and nutritional yeast, are fortified vitamin b12 deficiency in diabetic patients with. Vitamin B-12 may have a higher risk of becoming more vitamin B12 deficiency was found between vitamin 12! Dizziness, fatigue, and a fast heartbeat deficiency of B12 vitamin, the level of blood decreases!, dizziness, fatigue, and nutritional yeast, are fortified plasma and., hands, and nutritional yeast, are fortified no studies that explored the knowledge and perceptions of physicians vitamin. And nutritional yeast, are fortified people who do n't get enough vitamin may... Deficient in B12 How you can fulfill vitamin B12 levels already considered to deficient... National Library of Medicine these symptoms are pain and numbness in the presence of and. Available serum vitamin B12 deficiency may occur with metformin treatment time or dosage and! Than usual amounts of vitamin B12 deficiency was defined as serum levels less than 148 pmol/L 200...
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