There is a need to inject diabetic patients with a dose of 1mg. 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. First, one of the most common and most debilitating symptoms of vitamin B12 deficiency is extreme fatigue, tired all the time and in some patients also insomnia. Severe deficiency (e.g., pernicious anemia) may lead to macrocytic anemia, peripheral neuropathy, and mental-psychiatric disorders [ 9, 10 ]. BMJ 2010. c2181. [29] However, studies have shown that metformin actually has nothing to do with intestinal transit time and much more, with bacterial overgrowth, but instead it increases lactate production from the gut and the liver with accumulation in the enterocytes. An official website of the United States government. may email you for journal alerts and information, but is committed 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. Subsequently, every fifth patient in the clinic attendees was selected until the days desired sample size was reached. 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. 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. Cochrane Database Syst Rev. Moreover, neuropathy is not only because of prolonged diabetic conditions. Diabetic neuropathy is not associated with homocysteine, folate, vitamin B12 levels, and MTHFR C677T mutation in type 2 diabetic outpatients taking metformin. Vitamin deficiency anemia is a lack of healthy red blood cells caused by lower than usual amounts of vitamin B-12 and folate. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et alAmerican Diabetes Association; European Association for Study of Diabetes. Please try again soon. While in anemia, the number of healthy red blood cells to carry out oxygen depletes. By using metformin for a long period, the absorption of vitamin B12 will be reduced in your body. The duration of T2DM and duration of metformin use was significantly longer among females (p = 0.025 and P = 0.018, respectively) [Table 3]. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12deficiency: randomised placebo controlled trial. Additional data, including demographic characteristics were collected. 2014;29:96572, 13. de Jager J, Kooy A, Lehert P, Wulffele M, van der Kolk J, Bets D, et al Long-term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: Randomised placebo-controlled trial BMJ. Those taking a higher metformin dose had lower levels of vitamin B12 (coefficient: -0.061; CI 95%: -0.09, -0.024). In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. 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. In most cases, this depletion takes place 3 to 4 months after starting this therapy. Did you know that with a free Taylor & Francis Online account you can gain access to the following benefits? Vitamin B12 is an essential vitamin, and deficiency generally occurs with inadequate absorption or lack of dietary intake. https://www.uptodate.com/contents/search. You might be thinking about how you can take vitamin B12 naturally when you are a vegetarian. These symptoms are pain and numbness in the arms, legs, hands, and feet. 3099067 other information we have about you. This site needs JavaScript to work properly. Other disorders that interfere with the absorption and metabolism of vitamin B12 can also result in cobalamin deficiency, with the development of a macrocytic anemia and neurologic complications. A large percentage of physicians are not aware of the current recommendations of the American Diabetic Association (ADA) regarding vitamin B12 supplementation and screening. Endocrinol. 2016;59:42635, 31. Diabetic neuropathy is a debilitating complication of diabetes mellitus that affects about 50 % of diabetic patients, Diabetes Prevention program research group: long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. 2016;59:42635, 30. There were 210 patients (57.9%) who were on vitamin B12 supplementation, of which 111 (30.6%) had a daily dose of 200 mcg. We presented continuous variables as mean (standard deviation [SD]) or median (interquartile range [IQR]) as appropriate. Also, a single-centre nature of the study limits the generalisation of the study findings. 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 conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. 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. Clin Diabetes. [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. By Jay Furst. Federal government websites often end in .gov or .mil. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes J Korean Med Sci. 69 Vitamin B12 deficiency could be a modifiable risk factor for neuropathy in those patients. Long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. Meat consumption in Botswana increased by 0.3% between 1966 and 2011, primarily driven by beef, poultry and pork consumption.Citation22 The variation in the cut-off values for vitamin B12 deficiency across studies may also explain the wide variations in B12 deficiency from 5.8% to 52% in studies worldwide.Citation5,Citation6,Citation8,Citation10,Citation19,Citation20,Citation2325 In some studies, individuals with borderline vitamin B12 levels were further screened for evidence of elevated serum methylmalonic acid or homocysteine concentrations.Citation2 In this way, patients with borderline vitamin B12 levels were further categorised into those with or without vitamin B12 deficiency. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. information and will only use or disclose that information as set forth in our notice of 2010;340:c2181, 14. Routine vitamin B12 screening may prevent irreversible nerve damage in type-2 diabetes Patients with type-2 diabetes, taking metformin, should have their vitamin B12 levels assessed more regularly to avoid irreversible nerve damage, according to a new study presented at the Society for Endocrinology annual conference in Glasgow. Accessibility 965972. In both diabetes type 1 and type 2, diabetic patients experience its deficiency. Facts & Comparisons eAnswers. It has been suggested that healthy people can have low levels of vitamin B12, and much more vitamin B12 deficiency commonly occurs in around 6% of elderly patients aged 60 years with prevalence increasing with age. National Library of Medicine The mean age of the patients was 53.72 11.31 years (ranged from 25 to 84 years old). The questionnaire contained questions on their demographic profile, knowledge and practice of screening of Vitamin B12 level. You may search for similar articles that contain these same keywords or you may Its all about the vitamin B12 that gets absorbed into our blood from the small intestine. 2- Metformin containing Glumetza and Glucophage for treatment of diabetes type 2. However, you can prevent the B-12 deficiency by taking a proper diet and supplements. 2012;35:32733, 9. Vitamin B12 deficiency exists among patients with diabetes in the setting discussed. Front Microbiol. WebConclusion: Among patients with type 2 diabetes using metformin, the prevalence of vitamin B12 deficiency is higher than compared with patients not using metformin. 2021 Oct 18;2021:8745968. doi: 10.1155/2021/8745968. Because there is a possibility that taking vitamin B12 pills will not be the right choice for you. J. Clin. Metformin Treatment: A Potential Cause of Megaloblastic Anemia in Patients with Type 2 Diabetes Mellitus. Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy South Med J. Long AN, Atwell CL, Yoo W, Solomon SS. Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. The most notable risk factor associated with vitamin B12 deficiency in adult individuals with diabetes in clinical practice is long term and high dose metformin therapy [46]. 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. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? . 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. 1754-1761, 10.1210/jc.2015 The form was piloted on five medical records before using it. Chi-square test was used to determine significant difference between two proportions or groups. Treatment Of B12 Deficiency In Diabetes Patients. Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. sharing sensitive information, make sure youre on a federal Such conditions affect the activity of gut cells that in turn reduces the level of vitamin B12 when it passes through it. [2] The prevalence of diabetes in Saudi Arabia alone has increased to reach 7 million cases. Its due to metformin therapy that boosts vitamin B12 depletion in the human body. 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). 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. eCollection 2021. 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. According to a study, almost 22% of people with diabetes were low in B-12, suggesting that metformin is the reason. Irritability. However, our findings should be interpreted while considering several limitations. By closing this message, you are consenting to our use of cookies. [3], Metformin has been one of the most widely used antidiabetic agents taken orally. Approval was taken from and approved by the Institutional Review Board of MoH. Conclusions: Type 2 diabetes mellitus patients who were on metformin for at least 1 year were included in the study. Diabetes patients are often exposed to metformin, as it is an oral medication for hyperglycemia. This issue maybe debatable to some, but we think that there is a need for physicians to keep abreast with the latest recommendations and guidelines pertaining to management of diabetes. 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. PMC 2017;65:10616, 20. Clinical Implications of the Coexistence of Anemia and Diabetes Mellitus in the Elderly Population. 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. PN was significantly associated with female gender and poor glycemic control and was not associated vitamin B12 deficiency or metformin use. Lets read how type 1 and 2 diabetes affect the level of Vitamin B12 in your body. 2012;19:936. Of all the patients 17 were already considered to be deficient in B12. Its not only the vitamin B12 that we intake orally. Vitamin B12 deficiency is then easily missed. 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. Research on the use of vitamin B-12 for specific activities and conditions shows: Most people get enough vitamin B-12 from a balanced diet. Two common types of GERD medicines have been associated with B-12 deficiency to varying degrees: H-2-receptor blockers. 2009;32:193203, 28. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. MeSH How much vitamin B12 should a diabetic take? In the US, it is currently believed that adults with type 2 diabetes that are over 50 should take 2.4 g of synthetic vitamin B12 daily either in supplement form or in fortified food. 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. 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). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). People who take metformin for type 2 diabetes have lower levels of vitamin B12. Before 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. Estimation of Serum Vitamin B12 Levels Among the Elderly Population of Wardha City: A Cross-Sectional Study. Thus, you can take an intramuscular injection to boost the absorption of vitamin B12 in the blood. WebVitamin B12 deficiency is related to a number of comorbidities, such as peripheral neuropathy and megaloblastic anemia. No matter whether you have diabetes or not, never ignore peripheral and diabetic neuropathy. This site needs JavaScript to work properly. It depicts that vitamin B12 absorption is a calcium-dependent process. Used antidiabetic agents taken orally it depicts that vitamin B12 deficiency and metformin use and vitamin B12 levels among Elderly. 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Francis Online account you can prevent the B-12 deficiency to varying degrees: H-2-receptor blockers from Mayo Press! Study findings was used to determine significant difference between two proportions or groups continuous variables as mean ( standard [... Female gender and poor glycemic control and was not associated vitamin B12 that we orally., neuropathy is not only because of prolonged diabetic conditions sample size was.... People get enough vitamin B-12 for specific activities and conditions shows: most people get enough vitamin B-12 from balanced. Is highly prevalent, especially in patients with diabetes in Saudi Arabia alone has increased to reach 7 cases! Online account you can take an intramuscular injection to boost the absorption of B12... Proper diet and supplements peripheral and diabetic neuropathy Atwell CL, Yoo W, Solomon.... The arms, legs, hands, and feet and poor glycemic control and was not associated vitamin B12 is! 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