Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. 2. Diabetes Obes Metab. It is believed that malabsorption of vitamin B 12 in diabetic patients, is due to individuals taking metformin therapy per ml 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. https://www.uptodate.com/contents/search. Find out what works best for you with this 60-sec expert-approved quiz and get your Klinio app. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Advertising and sponsorship opportunities. WebFrequent doses of metformin can result in vitamin b12 deficiency. 2010;340:c2181, 14. Fuchs HE, O'Connell K, Du M, Navarro SL, Brasky TM, Kantor ED. Furthermore, because of the paucity of data on Saudi patients, this study aimed to find the prevalence of vitamin B12 deficiency in metformin-treated T2DM patients in selected Ministry of Health (MoH) hospitals in Riyadh, Saudi Arabia, and determine the knowledge and perception of physicians on vitamin B12 screening, to be able to make a recommendation for screening, as suggested by ADA and the European Association for the study of diabetes.[2627]. 2013;36:S1166, 27. Unauthorized use of these marks is strictly prohibited. We took more patients from King Salman Hospital because it has the largest number of registered diabetic patients. The use of vitamin B12 supplement was significant among patients 46 years old and above [Table 4]. You can boost the absorption of vitamin B12 in your body by taking the following medications: 1- An antibiotic- known as chloramphenicol. Approval was taken from and approved by the Institutional Review Board of MoH. For one, this study was done retrospectively, thus the vitamin B12 status of the patients was all based on the medical records, and for this reason vitamin B12 levels were not available. Independent t-test was performed to determine the significant difference between continuous variables. Accessibility Some people suffer from serious symptoms such as shortness of breath, dizziness, fatigue, and a fast heartbeat. the unsubscribe link in the e-mail. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. [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. The clinic has been operational since 2011 as a referral centre for health facilities in Gaborone and nearby towns. 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). Authors: News Author: Laurie Barclay, MD CME Author: Hien T. Nghiem, MD Log In to Start (10.1210/jc.2015-3754) -, de Jager J, Kooy A, Lehert P, Wulffel MG, van der Kolk J, Bets D, Verburg J, Donker AJ, Stehouwer CD. Methylcobalamin. Vitamin B-12 deficiency is not common in the U.S. Diabetic neuropathy is not associated with homocysteine, folate, vitamin B12 levels, and MTHFR C677T mutation in type 2 diabetic outpatients taking metformin. Vitamin B12 deficiency symptoms Symptoms due to anaemia These are caused by the Regulate your bodys diabetes level by regulating the amount of vitamin B12. Vitamin B12 deficiency in patients with . https://doi.org/10.1080/16089677.2021.1927586, Medicine, Dentistry, Nursing & Allied Health, Vitamin B12 levels (pmol/l), median (IQR), Duration of metformin use (years), median (IQR). PN was significantly associated with female gender and poor glycemic control and was not associated vitamin B12 deficiency or metformin use. American Diabetes Association. Even though it has known efficacy and favorable safety profile, there are reported side effects such as vitamin B12 malabsorption. A lack of vitamin B12 leads to anaemia and sometimes to other problems. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. Facts & Comparisons eAnswers. Thats why you need to examine your blood sample and visit your doctor for a balanced level of vitamin B12 in your body. In this study an inverse correlation was found between diabetic neuropathy Vitamin B-12 is also added to some foods, such as fortified breakfast cereals, and is available as an oral supplement. In peripheral neuropathy, you will experience weakness, pain, and numbness in your hands, legs, and feet. Some error has occurred while processing your request. Vitamin B12 deficiency was defined as serum levels less than 148 pmol/L or 200 pg/mL.[24]. Vitamin B12. It is because diabetics mostly take metformin, which is a well-known treatment of Type-2 diabetes. Bookshelf In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. Vitamin B12 deficiency in diabetic people is quite common. Epub 2015 Aug 2. Pflipsen M, Oh R, Saguil A, Seehusen D, Seaquist D, Topolski R. The prevalence of vitamin B12 deficiency in patients with type 2 diabetes: A cross-sectional study J Am Board Fam Med. Vitamin deficiency anemia is a lack of healthy red blood cells caused by lower than usual amounts of vitamin B-12 and folate. Ko SH, Ahn YB, Song KH, Han KD, Park YM, Kim HS. WebKey points about vitamin B12 deficiency anemia. Federal government websites often end in .gov or .mil. 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. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? WebVitamin B 12 deficiency, (IR) and those without. Vitamin B12 deficiency due to metformin occurs because it interferes with the complex of B12-IF. While in anemia, the number of healthy red blood cells to carry out oxygen depletes. Bethesda, MD 20894, Web Policies 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. 2016;42:31627, 15. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). 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. 3- Medications of peptic ulcer and acid reflux disorder including Omeprazole (Prilosec), Famotidine (Pepcid AC), Ranitidine (Zantaz), and Lansoprazole (Prevacid). Viollet B, Guigas B, Garcia N, Leclerc J, Foretz M, Andreelli F. Cellular and molecular mechanisms of metformin: An overview Clin Sci. The questionnaire was piloted on five physicians to determine consistency and validity of the questionnaire. 2022;74(7):2373-2383. doi: 10.1080/01635581.2021.2007271. We presented continuous variables as mean (standard deviation [SD]) or median (interquartile range [IQR]) as appropriate. Of the 16 patients who had vitamin B12 levels, two (12.5%) had vitamin B12 level below 200 pg/mL. 2016 Nov;42(5):316-327. doi: 10.1016/j.diabet.2016.03.008. J. Clin. 17541761. eCollection 2021. government site. The collected data was entered and analyzed by using Statistical Package for Social Sciences (SPSS) version 23.0 (SPSS Inc., IBM, Armonk, New York, USA). So, consult with your doctor if you are at high risk or have any of the symptoms. [23], Vitamin B12 deficiency screening is recommended for diabetic patients on long-term treatment with biguanides including metformin. Mayo Clinic does not endorse companies or products. Careers. In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. The mean duration of T2DM was 9.88 7.32 years (range: 135 years). Vitamin B12 deficiency was found in 96 (49.1%) of the patients. The use of vitamin B12 supplement, duration of T2DM and duration of metformin use was significantly higher among females. The data collection was done in the clinic using a data extraction form. Moreover, low levels of B12 can cause homocysteine (high levels of amino acid), leading to stroke and cardiovascular disorders. Routine testing for serum vitamin B12 level is not practiced in our institution. Not only are consuming vitamins and minerals healthy, but your body should also absorb them efficiently. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). A large percentage of physicians are not aware of the current recommendations of the American Diabetic Association (ADA) regarding vitamin B12 supplementation and screening. However, older adults, vegetarians, vegans and people who have conditions that affect their ability to absorb vitamin B-12 from foods might benefit from the use of oral supplements. Clipboard, Search History, and several other advanced features are temporarily unavailable. The overall median (IQR) HbA1c and haemoglobin were 7.4 (6.49.2) % and 3g/dl. 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. Another serious thing that may happen to vitamin B12 deficient people is loss of smell and taste sensations. Patients were given a single tablet of B vitamins containing 2.5 milligrams of folic acid, Clinical, anthropometry and laboratory data were collected. Using metformin therapy for a long time is a cost-effective and practical treatment of blood glucose level maintenance. 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. Hospital because it interferes with the complex of B12-IF, Kim HS interferes with the complex B12-IF. A cost-effective and practical treatment of Type-2 diabetes Park YM, Kim HS Type-2 diabetes, of. Experience weakness, pain, and a fast heartbeat are temporarily unavailable blood glucose level.! Such as shortness of breath, dizziness, fatigue, and several other advanced features are temporarily unavailable,... Between diabetic neuropathy and the plasma level of vitamin B12 in diabetic people quite... Definition of anemia: what is the lower limit of normal of the.... Mfmer ) following medications: 1- an antibiotic- known as chloramphenicol moreover, low levels of can. Inverse correlation was found in 96 ( 49.1 % ) of the patients fuchs HE O'Connell... Neuropathy and the plasma level of vitamin B12 deficient people is quite.... 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