In most cases, this depletion takes place 3 to 4 months after starting this therapy. -Chronic treatment should be done with an oral preparation in patients with normal intestinal absorption. Routine testing for serum vitamin B12 level is not practiced in our institution. Objective: Before [1], The number of persons with diabetes has risen from 108 million in 1980 to 422 million in 2014. The prevalence of vitamin B12 deficiency was 6.6%. However, diabetes type 2 can regulate glycemic amounts in blood in collaboration with the therapeutic effect of B12. 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 Vitamin B 12 deficiency associated with metformin is relatively common in our area. Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml 2016 Mar;39(3):305-14. doi: 10.1007/s40618-015-0365-9. Kumthekar AA, Gidwani HV, Kumthekar AB. Certain drugs may lead to modify the keyword list to augment your search. There was no difference in the prevalence of peripheral neuropathy in those with normal vitamin B12 levels and those with vitamin B12 deficiency. 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. Usual Adult Dose for B12 Nutritional Deficiency: 25 to 2000 mcg orally daily Usual Adult Dose for Schilling Test: 1000 mcg intramuscularly is the flushing dose Usual Pediatric Dose for B12 Nutritional Deficiency: 0.5 to 3 mcg daily Vitamin B12 is an essential micronutrient required for optimal hemopoetic, neuro-cognitive and cardiovascular function. 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. 5 Howick Place | London | SW1P 1WG. It presents with Long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. 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]. Taylor & Francis does not sell reprints or permissions for this article. The median (IQR) duration since the diagnosis of diabetes was 6 (212) years, and 89.5% of participants were on metformin. Severe deficiency (e.g., pernicious anemia) may lead to macrocytic anemia, peripheral neuropathy, and mental-psychiatric disorders [ 9, 10 ]. Lets read how type 1 and 2 diabetes affect the level of Vitamin B12 in your body. Elsaier A, Elamami A, Zaid A. Vitamin B12 deficiency in patients with type 2 diabetes on metformin therapy Ibnosina J Med Biomed Sci. Metformin Use Increases Vitamin B12 Deficiency in Patients With Diabetes The dose and duration of metformin is linked with vitamin B12 deficiency, which have implications for planning screening or prevention strategies in patients with diabetes. WebKey points about vitamin B12 deficiency anemia. 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. This content does not have an Arabic version. eCollection 2019. information and will only use or disclose that information as set forth in our notice of Hyperhomocysteinaemia and vitamin B12 deficiency are often detected in patients affected with diseases associated with neuropathy such as diabetes, 66 alcoholism, 67 Parkinsons disease (treated with L-dopa), 68 or HIV infection. Accessed Jan. 9, 2021. Such vitamins are vitamin B1, vitamin B6, biotin, thiamin, and pyridoxine. [Neuropsychiatric manifestations ushering pernicious anemia]. The questionnaire was piloted on five physicians to determine consistency and validity of the questionnaire. Fairfield KM. 2016 Nov;42(5):316-327. doi: 10.1016/j.diabet.2016.03.008. Diabetes Metab. Unauthorized use of these marks is strictly prohibited. We also inquired about the use of metformin, antacids, oral contraceptives and calcium supplements. You may be trying to access this site from a secured browser on the server. The overall median (IQR) HbA1c and haemoglobin were 7.4 (6.49.2) % and 3g/dl. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? 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. The study included 351 patients with a mean (SD) age of 57 (15) years and BMI of 29.49 (5.9) kg/m (Table 1). Metformin is the base of medicine in the treatment of type 2 diabetes mellitus (T2DM) with estimates that it is frequently approved and recommended to 120 million patients with diabetes globally. diabetes mellitus; diabetic neuropathies; malabsorption; metformin; prediabetic state; syndromes; vitamin B12. Vieira IH, Barros LM, Baptista CF, Rodrigues DM, Paiva IM. This content does not have an English version. Federal government websites often end in .gov or .mil. 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. Metab., 101 (2016), pp. Search for Similar Articles Registered in England & Wales No. Delusions. Besides this, diabetic neuropathy will also affect the gastrointestinal tract of your body. The prevalence of vitamin B12 deficiency increases with age due to either inadequate dietary intake or impaired vitamin B12 absorption.Citation37 Ageing is associated with decreases in taste acuity and smell, deteriorating dental health and a reduction of physical activity, which may all affect nutrient intake.Citation38 Insufficient nutritional intake of vitamin B12 accounts for about 2% of the vitamin B12 deficiency in the elderly, especially those living in institutions.Citation39 Vitamin B12 malabsorption is the most frequent cause of vitamin B12 deficiency in the elderly, accounting for about 40% to 70% of cases.Citation39,Citation40 It is caused by atrophic gastritis that occurs in 20% to 50% of the elderly population. The form was piloted on five medical records before using it. Diabetes Obes Metab. Please enable it to take advantage of the complete set of features! The patients on metformin had statistically lower 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. Irritability. Vitamin B12, being a water-soluble vitamin, is also known as cobalamin. https://www.micromedexsolutions.com. Higher doses of metformin and male sex were factors related to lower levels of vitamin B12. 2. The calculated sample size was 363. We took more patients from King Salman Hospital because it has the largest number of registered diabetic patients. There were 205 patients 56.5%) who had a daily dose of 750 mg of metformin. Please try after some time. [30] Metformin causes gastrointestinal disturbances when started at a higher dose and with long-term use through competitive inhibition or inactivation of Cb1 absorption, alterations in the intrinsic factor levels, interactions with the cubulin endocytic receptor, and antagonism of the calcium-dependent ileal membrane. Zhang YH, Guo W, Zeng T, Zhang S, Chen L, Gamarra M, Mansour RF, Escorcia-Gutierrez J, Huang T, Cai YD. The high consumption of meat among the Botswana population may explain the lower prevalence of vitamin B12 in our population than in other African settings. Vitamin B12 deficiency in diabetic people is quite common. [3], Metformin has been one of the most widely used antidiabetic agents taken orally. MeSH Fuchs HE, O'Connell K, Du M, Navarro SL, Brasky TM, Kantor ED. 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. 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. A total of 100 physicians responded and consented to participate in the study. 2014;127:816, 23. There are some limitations of this current study. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. 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. Using an assumed proportion of 9.4% (prevalence of vitamin b12 in T2DM patients on metformin), precision of 3% and an alpha of 5%. The .gov means its official. Proactively addressing the risk of developing low vitamin B 12 levels in this patient population not only reduces potential physical and mental sequelae but also lessens the financial burden of disease, appointments, testing, loss of The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). September 5, 2016. The average B12 level in the blood was 223pg/ml. The present study found no significant difference in the presence of neuropathy between those with normal and deficient vitamin B12 levels. 2017Last accessed on 2019 Jan 28 Available from: 3. No potential conflict of interest was reported by the author(s). 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. Cyanocobalamin. However, people who follow a vegetarian or vegan diet might be prone to deficiency because plant foods don't contain vitamin B-12. Approval was taken from and approved by the Institutional Review Board of MoH. Chapman L, Darling A, Brown J. World Health Organization. There was no vitamin B12 deficiency in 53 (45.4%) of the patients. Higher doses of metformin and male sex were factors related to lower levels of vitamin B12. So, consult with your doctor if you are at high risk or have any of the symptoms. 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. 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). WebConclusion: Among patients with type 2 diabetes using metformin, the prevalence of vitamin B12 deficiency is higher than compared with patients not using metformin. You can control blood glucose level in your body by increasing intake of vitamin B12. WebFrequent doses of metformin can result in vitamin b12 deficiency. Epub 2016 Apr 26. Mayo Clinic does not endorse companies or products. Haeusler S, Parry-Strong A, Krebs JD. It said: A paired t-test showed that in group A [the group given B12], patients with vitamin B12 To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. Epub 2022 May 20. Due to deficiency of B12 vitamin, the level of blood glucose decreases. information submitted for this request. A lack of vitamin B12 leads to anaemia and sometimes to other problems. Office of Dietary Supplements. It is because diabetics mostly take metformin, which is a well-known treatment of Type-2 diabetes. Despite its effectiveness, you should consult your doctor after a couple of months for proper screening. 2016;42:31627, 15. Abstract Background Metformin is first-line therapy for patients with diabetes. government site. 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. It presents with diverse clinical manifestations ranging from impaired memory, dementia, delirium, peripheral neuropathy, sub acute combined degeneration of the spinal cord, megaloblastic anemia and pancytopenia. 2021 Jul 9;12:711244. doi: 10.3389/fmicb.2021.711244. Make sure to take a regular intake of this vitamin for diabetes and treatment of other diseases. HHS Vulnerability Disclosure, Help Vitamin deficiency anemia is a lack of healthy red blood cells caused by lower than usual amounts of vitamin B-12 and folate. Front Microbiol. If you are a Mayo Clinic patient, this could Vitamin B-12 is an essential vitamin for diabetes patients as it promotes healthy blood cells and nervous system. 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. Table 1 shows the clinicodemographic profile of all patients. So, it was not possible to get a valid estimate of the deficiency prevalence. The first possible treatment option is to look at your diet. Metformin and vitamin B12 deficiency: where do we stand? A cross-sectional study was conducted with 162 patients. [23], Vitamin B12 deficiency screening is recommended for diabetic patients on long-term treatment with biguanides including metformin. [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. Not feeling as hungry as usual. 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. Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind. Treatment Of B12 Deficiency In Diabetes Patients. In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. Bethesda, MD 20894, Web Policies Never take a supplement or injection at your own decision. The latter protects vitamin B12 from pancreatic digestion.Citation36, In this study, participants with vitamin B12 deficiency were significantly older than those with normal vitamin B12 levels. 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. PMC Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. While the recommended daily amount of vitamin B-12 for adults is 2.4 micrograms, higher doses have been found to be safe. 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 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. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). 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