2010;103:2657, 7. 2006;35:2001, 6. Metformin associated B12 deficiency J Assoc Physicians India. Subsequently, every fifth patient in the clinic attendees was selected until the days desired sample size was reached. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. https://naturalmedicines.therapeuticresearch.com. Authors: News Author: Laurie Barclay, MD CME Author: Hien T. Nghiem, MD Log In to Start Though vitamin B12 is commonly taken to increase energy levels, evidence showing that B12 supplements improve energy levels in people without a deficiency is lacking. official website and that any information you provide is encrypted 965972. The majority were females (67.2%) and those with type 2 diabetes (92.9%). People who take metformin for type 2 diabetes have lower levels of vitamin B12. (10.2337/dc11-1582) [Figure 1] A total of 51 (51.0%) order vitamin B12 testing supplementation only if they have symptoms of neuropathy, 9 (9.0%) if patients have anemia, 19 (19.0%) routinely order vitamin B12 testing, and 21 (21.0%) never prescribe vitamin B12 to their patients [Figure 2]. These symptoms are pain and numbness in the arms, legs, hands, and feet. Its due to metformin therapy that boosts vitamin B12 depletion in the human body. 2014;349:g5226, 26. The data collection was done in the clinic using a data extraction form. The mean duration of T2DM was 9.88 7.32 years (range: 135 years). World Health Organization. Epub 2015 Sep 4. Lam DW, LeRoith D. The worldwide diabetes epidemic Curr Opin Endocrinol Diabetes Obes. Vitamin B12 is an essential micronutrient required for optimal hemopoetic, neuro-cognitive and cardiovascular function. You may be trying to access this site from a secured browser on the server. When you do not treat your vitamin B12 deficiency, you may face severe diabetic complications. FOIA Also, add a good amount of green leafy vegetables to your diet. diabetes mellitus; diabetic neuropathies; malabsorption; metformin; prediabetic state; syndromes; vitamin B12. PMC BMC Pharmacol Toxicol. Delusions. 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. This can happen if you don't eat Recommendations for Practical Use of Metformin, a Central Pharmacological Therapy in Type 2 Diabetes. Accessibility 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. 2009;22:52834, 8. 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 present study found no significant difference in the presence of neuropathy between those with normal and deficient vitamin B12 levels. Table 1: Baseline characteristics of patients with diabetes at Princess Marina hospital diabetes clinic, between July 2017 and October 2017 (n=351). WebVitamin B 12 deficiency, (IR) and those without. Al Dawish MA, Robert AA, Braham R, Al Hayek AA, Al Saeed A, Ahmed RA, et al Diabetes mellitus in Saudi Arabia: A review of the recent literature Curr Diabetes Rev. Those taking a higher metformin dose had lower levels of vitamin B12 (coefficient: -0.061; CI 95%: -0.09, -0.024). Metformin-induced vitamin B12 deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy in the patient with diabetes. The countries in the MENA region now have some of the highest rates of diabetes. 2015 Aug;31(4):184-189. doi: 10.1177/8755122515576207. The mean HbA1c for all patients was 8.45 2.01% (range: 4.2316.0). 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). Identification of Microbiota Biomarkers With Orthologous Gene Annotation for Type 2 Diabetes. Vitamin B12 deficiency was defined as serum levels less than 148 pmol/L or 200 pg/mL.[24]. People with diabetes taking metformin are at a higher risk of developing B12 deficiency, because this medication can reduce vitamin B12 absorption in the body . The patients on metformin had statistically lower "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. We use cookies to improve your website experience. Russo GT, Giandalia A, Romeo EL, Scarcella C, Gambadoro N, Zingale R, Forte F, Perdichizzi G, Alibrandi A, Cucinotta D. J Endocrinol Invest. Diabetic neuropathy is not associated with homocysteine, folate, vitamin B12 levels, and MTHFR C677T mutation in type 2 diabetic outpatients taking metformin. Office of Dietary Supplements. 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). Taylor & Francis does not sell reprints or permissions for this article. PMC A total of 6 of the 16 patients (37.5%) used PPI, and 11 (68.8%) had Vitamin B12 supplementation. Vitamin B 12 deficiency associated with metformin is relatively common in our area. other information we have about you. In diabetes, blood glucose level goes low Short-term memory loss. A lack of vitamin B12 leads to anaemia and sometimes to other problems. 2022 Jan;40(1):97-107. doi: 10.2337/cd21-0043. eCollection 2020. 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. include protected health information. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. 327333. 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 Symptoms of potential nervous system problems include: Confusion. Loss of balance. Background: Type 2 diabetes mellitus is associated with vitamin B12 deficiency which is further increased in patients who are on metformin therapy. Ahmed M, Muntingh G, Rheeder P. Vitamin B12 deficiency in metformin-treated type-2 diabetes patients, prevalence and association with peripheral neuropathy BMC Pharmacol Toxicol. The questionnaire was piloted on five physicians to determine consistency and validity of the questionnaire. 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. 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Vitamin B12 is a water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function.Citation1 The prevalence of vitamin B12 deficiency in diabetes mellitus (DM) ranges between 5.8% and 52%.Citation28 The association of vitamin B12 deficiency and Type 2 diabetes (T2DM) is mainly due to metformins long-term use, as demonstrated by evidence from both observational and interventional studies.Citation1,Citation8 This associations exact mechanism is unknown but has been ascribed to intestinal malabsorption of vitamin B12 due to metformin.Citation9,Citation10 Pernicious anaemia, which is characterised by an autoimmune-mediated chronic atrophic gastritis, is a classically described cause of vitamin B12 deficiency among type 1 diabetes patients.Citation11 As vitamin B12-related hematologic and neuropsychiatric disorders are reversible by early diagnosis, regular assessment of vitamin B12 levels is essential.Citation2 Prompt treatment may be important in patients with diabetes.Citation12 As the prevalence of vitamin B12 deficiency in patients with diabetes in Botswana is unknown, this study was undertaken to estimate the prevalence of Vitamin B12 deficiency among patients with diabetes. 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). The average B12 level in the blood was 223pg/ml. sharing sensitive information, make sure youre on a federal Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. 5 Howick Place | London | SW1P 1WG. The clinic has been operational since 2011 as a referral centre for health facilities in Gaborone and nearby towns. 2022;74(7):2373-2383. doi: 10.1080/01635581.2021.2007271. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. Diabetes mellitus (DM) is a chronic metabolic disease with increasing prevalence worldwide. 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. Federal government websites often end in .gov or .mil. Conclusions In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B 12 plasma levels. Table 2: Factors associated with Vitamin B12 deficiency among patients with diabetes at Princess Marina Hospital diabetes clinic, between July 2017 and October 2017. Methylcobalamin. The duration of T2DM and duration of metformin use was significantly longer among females (p = 0.025 and P = 0.018, respectively) [Table 3]. So, it was not possible to get a valid estimate of the deficiency prevalence. Vitamin B12 deficiency symptoms Symptoms due to anaemia These are caused by the 2016 Nov;42(5):316-327. doi: 10.1016/j.diabet.2016.03.008. Did you know that with a free Taylor & Francis Online account you can gain access to the following benefits? Vitamin B-12 supplements also are recommended for women who are pregnant or breastfeeding exclusively and follow vegetarian or vegan diets. https://www.micromedexsolutions.com. Several studies have unequivocally demonstrated that vitamin B12 deficiency is highly prevalent in adult diabetic patients [24]. In this study, we aimed to evaluate the prevalence of vitamin B12 deficiency in patients with chronic metformin use and the relationship between vitamin B12 deficiency and diabetic neuropathy. Besides an imbalance diet, undersupply of IF (Intrinsic Factor) protein also causes vitamin B12 deficiency. 2008;89:693S6S, 29. 69 Vitamin B12 deficiency could be a modifiable risk factor for neuropathy in those patients. Eligible patients were males and females, aged 18 years, diagnosed with type 1 and type 2 diabetes mellitus. BMJ 2010. c2181. Aust Fam Physician. -, Reinstatler L, Qi YP, Williamson RS, Garn JV, Oakley GP Jr. Association of biochemical B12 deficiency with metformin therapy and vitamin B12supplements: the National Health and Nutrition Examination Survey, 19992006. Cureus. Although it is validated for evaluating peripheral neuropathy, it is prone to subjectivity as it is symptom dependent.Citation14 Modified Toronto Clinical Neuropathy Score (m-TCNS) with better reliability is an alternative in subsequent studies.Citation55. Routine testing for serum vitamin B12 level is not practiced in our institution. Causes and pathophysiology of vitamin B12 and folate deficiencies. People with diabetes type 1 are usually at higher risk of getting autoimmune disorders like thyroid problems and coeliac disease. In short, the long-term deficiency of vitamin B12 causes serious symptoms like depression, delusion, difficulty in walking, loss of mobility, seizures, and dementia. 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