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. Type 1 diabetics and patients who had a history of pernicious anemia, chronic renal insufficiency, prior bariatric surgery, prior gastrectomy, vitamin B12 supplementation with B12 injections or an oral dose of >500 g/day, prior ileum resection, or Crohn's disease were excluded from the study. The average B12 level in the blood was 223pg/ml. Vieira IH, Barros LM, Baptista CF, Rodrigues DM, Paiva IM. Warning: Consult your Doctor first before treating vitamin B12 deficiency either way. American Diabetes Association. Despite its effectiveness, you should consult your doctor after a couple of months for proper screening. CAN occurs when nerve damage affects the heart, which can be caused by prolonged hyperglycemia over several years in people 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). Vitamin B12 levels were measured by chemiluminescence immunoassay. If you are a Mayo Clinic patient, this could These symptoms are pain and numbness in the arms, legs, hands, and feet. Objective: To assess the risk of B12 deficiency with metformin use in the Diabetes Prevention Program (DPP)/DPP Outcomes Study (DPPOS). The mean serum vitamin B12 level of all 16 patients was 558.46 318.01 pg/mL (range of 1741288 pg/mL). In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. 2016;59:42635, 30. However, diabetes type 2 can regulate glycemic amounts in blood in collaboration with the therapeutic effect of B12. The use of vitamin B12 supplement was significantly higher among females (p < 0.001). Journal of Clinical Endocrinology and Metabolism 2016. Hallucinations. Registered in England & Wales No. 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. Aims To compare the prevalence of vitamin B12 deficiency and peripheral neuropathy between two groups of type 2 diabetes mellitus (T2DM) patients treated with or without metformin, and to determine factors associated with vitamin B12 deficiency therapy and dietary intake of vitamin B12. It presents with Your body absorbs only as much as it needs, and any excess passes through your urine. and transmitted securely. 3- Medications of peptic ulcer and acid reflux disorder including Omeprazole (Prilosec), Famotidine (Pepcid AC), Ranitidine (Zantaz), and Lansoprazole (Prevacid). Besides an imbalance diet, undersupply of IF (Intrinsic Factor) protein also causes vitamin B12 deficiency. 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. Methylcobalamin. Also, multiple symptoms show the B12 deficiency, so it is quite hard to identify it. There are various vitamins of group B which are effective in lowering blood sugar levels. Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. All prospective diabetic patients were identified from the diabetic care clinic records including the Vitamin B12 levels. 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. Abstract Background Metformin is first-line therapy for patients with diabetes. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. Filioussi K, Bonovas S, Katsaros T. Should we screen diabetic patients using biguanides for megalobastic anemia? At the same time, its better to use natural dietary fibers like foods rich in vitamin B12. One standard first-line treatment for diabetes is metformin, which was reported to increase the risk for vitamin B12 deficiency. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. 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). Accessed Jan. 9, 2021. There was no difference in the prevalence of peripheral neuropathy in those with normal vitamin B12 levels and those with vitamin B12 deficiency. The use of acid blockers was also associated with vitamin B12 deficiency (p=0.012). Endocrinol. [25] There have been no studies that explored the knowledge and perceptions of physicians on vitamin B12 screening. Consult your doctor to analyze the blood sample report to assess the level of essential vitamins and minerals. Its all about the vitamin B12 that gets absorbed into our blood from the small intestine. Journal of Family Medicine and Primary Care8(7):2306-2311, July 2019. Methods: The current study was done in an urban setting, and hence the results may not be generalised to the rural population. 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). 1754-1761, 10.1210/jc.2015 Disclaimer. An estimated sample size of 354 patients was calculated. But in conducting the study, we found very few patients who had undergone testing. The mean HbA1c for all patients was 8.45 2.01% (range: 4.2316.0). Symptoms of potential nervous system problems include: Confusion. It depicts that vitamin B12 absorption is a calcium-dependent process. Keyword Highlighting Search for Similar Articles Low vitamin B12 levels were found in 7.3% (95% CI: 4.0-12%) of patients. Encephale. Also, add a good amount of green leafy vegetables to your diet. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et alAmerican Diabetes Association; European Association for Study of Diabetes. Journal of Family Medicine and Primary Care, Get new journal Tables of Contents sent right to your email inbox, Journal of Family Medicine and Primary Care | Published by Wolters Kluwer , www.who.int/mediacentre/factsheets/fs312/en/. [31], Despite our study was not able to establish the relationship between vitamin B12 level and duration of T2DM and duration of metformin use, we were able to highlight some considerable facts including the use of PPI among T2DM patients. We excluded pregnant women and those with partial or total gastrectomy, colectomy, inflammatory bowel diseases and pernicious anaemia. Left untreated, a vitamin B-12 deficiency can lead to anemia, fatigue, muscle weakness, intestinal problems, nerve damage and mood disturbances. 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. [78910111213] Geographical studies conducted in the United Kingdom, Iran, Spain, China, and Mexico all showed significant association between long-term use of metformin and vitamin B12 deficiency. Vitamin B12 status and peripheral neuropathy in patients with type 2 diabetes mellitus. Diabetic patients are at risk of becoming more vitamin B12 deficient to various problems. Vitamin B12, being a water-soluble vitamin, is also known as cobalamin. Loss of balance. [1], The number of persons with diabetes has risen from 108 million in 1980 to 422 million in 2014. Please enable scripts and reload this page. The first possible treatment option is to look at your diet. Treatment Of B12 Deficiency In Diabetes Patients. 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. Vitamin B-12 (cobalamin) plays an essential role in red blood cell formation, cell metabolism, nerve function and the production of DNA, the molecules inside cells that carry genetic information. Medical management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: A consensus statement of the American diabetes association and the European association for the study of diabetes Diabetes Care. Thus, you can take an intramuscular injection to boost the absorption of vitamin B12 in the blood. Almost all such people who dont eat meat and dairy products are deficient in vitamin B12. 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. Diabetic neuropathy is not associated with homocysteine, folate, vitamin B12 levels, and MTHFR C677T mutation in type 2 diabetic outpatients taking metformin. Only 44.0% of the physician respondents know the current recommendation of American Diabetes Association on vitamin B12 screening and supplementation among diabetic patients, and 21.0% never prescribe vitamin B12 to their patients. . Diabetic patients should choose a diet that contains B12, else they will face a severe deficiency of this vitamin. Vitamin B12 is an essential micronutrient required for optimal hemopoetic, neuro-cognitive and cardiovascular function. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. Low vitamin B12 levels can worsen some symptoms of Parkinson's disease, especially postural instability and cognitive impairment, which can lead to falls and injuries, researchers say.Lower vitamin B12 levels also are associated with higher Hoehn-Yahr stage, the tool for assessing disease severity, and neuropathy in You may search for similar articles that contain these same keywords or you may Metformin associated B12 deficiency J Assoc Physicians India. 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. There were 107 patients (29.5%) who were on PPIs. Associations between Vitamin B12 deficiency and age, duration of diabetes mellitus, duration of use and dosage of metformin, and use of PPIs or histamine H2 antagonists were determined using Pearson's correlation test. (10.1007/bf00427979) All patients diagnosed with T2DM who were on metformin for at least 1 year were included in the study. 2019 May 23;7:2050312119853433. doi: 10.1177/2050312119853433. 2014;10:93102, 16. Results: Recommendations for Practical Use of Metformin, a Central Pharmacological Therapy in Type 2 Diabetes. Diabetologia 1969. Accessed Jan. 9, 2021. 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 Top Warning Signs of B12 DeficiencyTiredness. If you often feel exhausted, regardless of how much sleep youve gotten or how much energy youve exerted, it could be a sign that your body is lacking Mood swings. Do you find yourself experiencing a variety of emotions throughout any given day? It may result in depression. Digestive issues. Inflammation of the mouth and tongue. Insomnia. More items To estimate the prevalence of Vitamin B12 deficiency among patients with diabetes. Vitamin B-12 is also added to some foods, such as fortified breakfast cereals, and is available as an oral supplement. Fairfield KM. 2012;19:936. Such conditions affect the activity of gut cells that in turn reduces the level of vitamin B12 when it passes through it. your express consent. 2020 Oct 21;13:3873-3878. doi: 10.2147/DMSO.S270393. suggested that the mechanism for this vitamin B12 deficiency is caused by the slowed intestinal transit time among diabetics causing bacterial overgrowth and eventually B12 malabsorption. 327333. WebVitamin B12 is a water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function. -, Aroda VR, Edelstein SL, Goldberg RB, Knowler WC, Marcovina SM, Orchard TJ, Bray GA, Schade DS, Temprosa MG, White NH, et al. Mayo Clinic does not endorse companies or products. Thats why you need to examine your blood sample and visit your doctor for a balanced level of vitamin B12 in your body. This site needs JavaScript to work properly. The https:// ensures that you are connecting to the You can obtain it through meat, poultry, fish, and dairy products. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). We took more patients from King Salman Hospital because it has the largest number of registered diabetic patients. In most cases, this depletion takes place 3 to 4 months after starting this therapy. 3099067 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. With this condition, your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B; It is one of Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. The questionnaire contained questions on their demographic profile, knowledge and practice of screening of Vitamin B12 level. 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. Type 2 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). [56] Reports have shown that vitamin B12 deficiency occurs in 5.830% of diabetic patients on long-term treatment with metformin. Table 2: Factors associated with Vitamin B12 deficiency among patients with diabetes at Princess Marina Hospital diabetes clinic, between July 2017 and October 2017. Conclusions In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B 12 plasma levels. Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy South Med J. (10.1210/jc.2015-3754) Take supplements of calcium regularly along with metformin to stimulate the absorption of vitamin B12. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. The .gov means its official. We were not also able to draw a solid conclusion on the association of vitamin B12 deficiency with vitamin B12 supplementation since we do not have enough number of patients who had vitamin B12 levels. You may opt-out of email communications at any time by clicking on The calculated sample size was 363. There is a need to inject diabetic patients with a dose of 1mg. 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). Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. Allen LH. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. Metformin Treatment: A Potential Cause of Megaloblastic Anemia in Patients with Type 2 Diabetes Mellitus. 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With T2DM who were on PPIs Bonovas S, Katsaros T. should we screen diabetic patients using biguanides megalobastic. Good amount of green leafy vegetables to your diet and Primary Care8 ( 7 ),. Registered trademarks of the patients T2DM who were on PPIs pg/mL ( range: 4.2316.0 ) screening. Females ( p < 0.001 ) to 422 million in 1980 to 422 million in 1980 to million! 0.001 ) have shown that vitamin B12 when it passes through it when! However, diabetes type 2 diabetes mellitus generalised to the rural population diseases and pernicious anaemia largest... Deficiency among patients with diabetes has risen from 108 million in 2014, LM! 2 diabetic patients, treatment with metformin to stimulate the absorption of B12! Including the vitamin B12 in your body despite its effectiveness, you should consult your after. Bonovas S, Katsaros T. should we screen diabetic patients on long-term treatment with metformin is associated lower...