You may also suffer from diabetic neuropathy due to a lack of vitamin B12. Before Using an assumed proportion of 9.4% (prevalence of vitamin b12 in T2DM patients on metformin), precision of 3% and an alpha of 5%. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. Metformin associated B12 deficiency J Assoc Physicians India. Taking this diabetes drug might reduce your body's ability to absorb vitamin B-12. Metformin Treatment: A Potential Cause of Megaloblastic Anemia in Patients with Type 2 Diabetes Mellitus. Patients were given a single tablet of B vitamins containing 2.5 milligrams of folic acid, Cureus. 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. Metformin and the gastrointestinal tract Diabetologia. Similar findings have been previously reported in different settings.Citation20,Citation4749 In the current study, NTSS-6 was used to assess neuropathy. J. Clin. Vitamin B12, being a water-soluble vitamin, is also known as cobalamin. This site needs JavaScript to work properly. 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. 2009;22:52834, 8. Medicina (Kaunas). -, Aroda VR, Edelstein SL, Goldberg RB, Knowler WC, Marcovina SM, Orchard TJ, Bray GA, Schade DS, Temprosa MG, White NH, et al. Its not only the vitamin B12 that we intake orally. 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 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. The Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml 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. Accessed Jan. 9, 2021. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. doi: 10.7759/cureus.28194. In conclusion, the study demonstrated that vitamin B12 deficiency exists among diabetes patients attending Princess Marian Hospital diabetes clinic. When it comes to increasing the level of vitamins for diabetes, people usually take supplements. Though all vegetables and plants dont have vitamin B12, there are still some plant-based sources. 2009;32:193203, 28. This cross-sectional study was undertaken on 351 patients with diabetes at a specialised public diabetes clinic in Gaborone between July 2017 and October 2017. 1754-1761, 10.1210/jc.2015 Despite its effectiveness, you should consult your doctor after a couple of months for proper screening. 2022 Aug;24(8):1423-1428. doi: 10.1111/dom.14734. The average B12 level in the blood was 223pg/ml. Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. In this study, we found that only 4.4% of the study population had available serum vitamin B12 levels, which means that serum levels of vitamin B12 are not routinely requested. 8600 Rockville Pike Encephale. Methods: Of all the patients 17 were already considered to be deficient in B12. 3- How much vitamin B12 can you take in metformin therapy for diabetics? doi: 10.1002/14651858.CD004514. Albai O, Timar B, Paun DL, Sima A, Roman D, Timar R. Diabetes Metab Syndr Obes. Authors: News Author: Laurie Barclay, MD CME Author: Hien T. Nghiem, MD Log In to Start Another limitation is that we could have collected/determined the homocysteine levels, holotranscobalamin, methylmalonic acid, and red blood cell B12 of the patients, which could have helped us determine if there is true tissue deficiency of vitamin B12, that will help us determine vitamin B12 deficiency when no laboratory determination of serum vitamin B12 level is available. He is also a recipient of several awards and honors. Besides this, diabetic neuropathy will also affect the gastrointestinal tract of your body. From a sampling frame of a list of all patients attending the diabetes clinic during the study period, we used a systematic random sampling of 10 participants each day. Clipboard, Search History, and several other advanced features are temporarily unavailable. Vitamin B12 deficiency is then easily missed. 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]. Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. 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). Taking omeprazole (Prilosec), lansoprazole (Prevacid) or and transmitted securely. The prevalence of vitamin B12 deficiency in the present study is comparable to reports from Brazil and Korea but lower than previously described in African countries.Citation8,Citation1921 For instance, the prevalence of vitamin B12 deficiency in South Africa and Uganda was (28%) and (10.7%), respectively.Citation20,Citation21 The variations in diets across communities may partly explain the differences in the prevalence of vitamin B12 deficiency across studies. Avoid drinking goat milk because its low in folate and vitamin B12. Type 2 Diabetes Vitamin B12 Deficiency Hyperhomocysteinemia: Due to high cost for investigation serum homocysteine level was measured only in 6 patients and serum vitamin B12 level (cheaper test) was measured in 14 patients with prior permission from Ethics Committee. Of all the patients 17 were already considered to be deficient in B12. Well, vitamin B12 does not play a role in the management of blood glucose levels. Reinstatler L, Qi YP, Williamson RS, Garn JV, Oakley GP Jr. Association of biochemical B12 deficiency with metformin therapy and vitamin B12 supplements: The National Health and Nutrition Examination Survey 1999-2006 Diabetes Care. We excluded pregnant women and those with partial or total gastrectomy, colectomy, inflammatory bowel diseases and pernicious anaemia. 8600 Rockville Pike There were only 16 patients (4.4%) who had available serum vitamin B12 levels. Accessed Jan. 9, 2021. 2016;59:42635, 30. WebNo correlation was found between vitamin B 12 plasma levels and metformin treatment time or dosage. eCollection 2019. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Federal government websites often end in .gov or .mil. There were 41 (41.0%) males and 59 (59.0%) females. There are various vitamins of group B which are effective in lowering blood sugar levels. Higher doses of metformin and male sex were factors related to lower levels of vitamin B12. [28] Type 2 diabetics particularly those on metformin are at risk for metabolically lower levels of vitamin B12. 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. Unlike diabetes type 1, diabetic patients with type 2 diabetes have a 10% more risk of getting its deficiency. In peripheral neuropathy, you will experience weakness, pain, and numbness in your hands, legs, and feet. Treatment Of B12 Deficiency In Diabetes Patients. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et alAmerican Diabetes Association; European Association for Study of Diabetes. People with diabetes type 1 are usually at higher risk of getting autoimmune disorders like thyroid problems and coeliac disease. HHS Vulnerability Disclosure, Help Vitamin B-12 injections or nasal spray might be prescribed to treat vitamin B-12 deficiency. Background: Type 2 diabetes mellitus is associated with vitamin B12 deficiency which is further increased in patients who are on metformin therapy. 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. https://www.uptodate.com/contents/search. Problems concentrating. 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. 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. 2016;134:4739, 22. Did you know that with a free Taylor & Francis Online account you can gain access to the following benefits? Your body absorbs only as much as it needs, and any excess passes through your urine. Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. This content does not have an Arabic version. The .gov means its official. Severe deficiency (e.g., pernicious anemia) may lead to macrocytic anemia, peripheral neuropathy, and mental-psychiatric disorders [ 9, 10 ]. WebVitamin B 12 deficiency, (IR) and those without. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Berchtold P, Bolli P, Arbenz U, Keiser G. Disturbance of intestinal absorption following metformin therapy (observations on the mode of action of biguanides) [in German]. In addition, female patients had higher levels of vitamin B12 compared to men (coefficient: 49.1; CI 95%: 2.3-95). Your message has been successfully sent to your colleague. An estimated sample size of 354 patients was calculated. 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). 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. Owhin SO, Adaja TM, Fasipe OJ, Akhideno PE, Kalejaiye OO, Kehinde MO. 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. Consult your doctor to analyze the blood sample report to assess the level of essential vitamins and minerals. [1], The number of persons with diabetes has risen from 108 million in 1980 to 422 million in 2014. The two tests are recommended to evaluate intracellular vitamin B12 status better, especially in borderline vitamin B12 deficiency.Citation54 Parietal cell and intrinsic factor antibodies status were not correlated with the confirmed vitamin B12-deficient patients to exclude them from this study due to the unavailability of antibody tests in our local setting. Advertising revenue supports our not-for-profit mission. Their mean daily dose of metformin was 828.13 150.52 mg (range of 5001000 mg). sharing sensitive information, make sure youre on a federal A large percentage of physicians are not aware of the current recommendations of the American Diabetic Association (ADA) regarding vitamin B12 supplementation and screening. information highlighted below and resubmit the form. Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. We used a researcher-administered questionnaire to obtain information on patients age, sex, HIV status, diabetes type and diabetes duration. However, people who follow a vegetarian or vegan diet might be prone to deficiency because plant foods don't contain vitamin B-12. health information, we will treat all of that information as protected health
World J Diabetes. 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. There is a problem with
RESULTS Biochemical B 12 deficiency was present in 5.8% of those with diabetes using metformin compared with 2.4% of those not using metformin ( P = 0.0026) and 3.3% of those Diabetes: Fact sheet [Internet]. Vitamin B12: Fact sheet for professionals. J Pharm Technol. This content does not have an English version. Diabetic gastroparesis is a severe diabetic complication refers to delayed gastric emptying in the absence of mechanical obstruction of the stomach. 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. The questionnaire contained questions on their demographic profile, knowledge and practice of screening of Vitamin B12 level. 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). Also, add a good amount of green leafy vegetables to your diet. But prolonged vitamin B12 deficiency can also cause it. Bookshelf Diabetologia 1969. There were 206 (56.7%) males and 157 (43.3%) females, and 337 (92.8%) were Saudis. Comparisons of demographics and other clinical characteristics between vitamin B12-deficient participants against those normal levels were through Students t-test or Wilcoxon signed-rank test for continuous variables and chi-square or Fishers exact test for categorical variables. Thats why you need to examine your blood sample and visit your doctor for a balanced level of vitamin B12 in your body. Hunt A, Harrington D, Robinson S. Vitamin B12 deficiency Bmj. ated type 2 diabetes mellitus 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. T2DM is a significant risk factor to the development of ischemic stroke. Epub 2015 Mar 9. Lets read how type 1 and 2 diabetes affect the level of Vitamin B12 in your body. You can control blood glucose level in your body by increasing intake of vitamin B12. Fairfield KM. Vitamin B12 deficiency symptoms Symptoms due to anaemia These are caused by the Severe peripheral neuropathy has, however, been reported among T2DM patients.Citation5052 This is common among patients on metformin due to drug-induced vitamin B12 deficiency.Citation50,Citation53 Vitamin B12 deficiency causes elevated homocysteine and methylmalonic acid, which has been shown to have potentially toxic effects on neurons. World Health Organization. Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. Metformin therapy and assessment for vitamin B12 deficiency: is it necessary? WebVitamin B-12 deficiency anemia is a condition in which your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B-12. 2016;42:31627, 15. The mean serum vitamin B12 level of all 16 patients was 558.46 318.01 pg/mL (range of 1741288 pg/mL). Standards of medical care in diabetes Diabetes Care. 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/. 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. Am J Clin Nutr. Mayo Clinic does not endorse any of the third party products and services advertised. Approvals were taken from the directors of the four hospitals prior to data collection. [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. 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). 2021 Jul 15;12(7):916-931. doi: 10.4239/wjd.v12.i7.916. If a patients mood is low at the same time, this can easily be interpreted as depression. You may opt-out of email communications at any time by clicking on
2010;340:c2181, 14. Recommendations: It is strongly advised based on the findings of this study that Serum cobalamin levels should be measured in Type II diabetes patients who are 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). Epub 2021 Nov 24. This can happen if you don't eat 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]. A p-value of less than 0.05 was considered significant. [Neuropsychiatric manifestations ushering pernicious anemia]. 2016;59:42635, 31. The NTSS-6 questionnaire was the only tool used to assess peripheral neuropathy. Hallucinations. We also inquired about the use of metformin, antacids, oral contraceptives and calcium supplements. Vitamin B12 deficiency in diabetic people is quite common. There were 39 diabetic patients, 16 took metformin for at least 1 year. Most (89.5%) participants were on metformin. According to a study, almost 22% of people with diabetes were low in B-12, suggesting that metformin is the reason. Table 1 shows the clinicodemographic profile of all patients. 2014;127:816, 23. Registered in England & Wales No. Vitamin B1: Aids the breakdown of carbohydrates.Vitamin B2 Aids the metabolism of carbohydrates, protein, and fat.Vitamin B3 Aids the metabolism of carbohydrates, fat, and alcohol.Vitamin B5 Aids the metabolism of carbohydrates, protein, fat, and alcohol.Vitamin B6 Aids the metabolism of carbohydrates and protein.More items (10.1007/bf00427979) The current study was done in an urban setting, and hence the results may not be generalised to the rural population. 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. [23], Vitamin B12 deficiency screening is recommended for diabetic patients on long-term treatment with biguanides including metformin. Its all about the vitamin B12 that gets absorbed into our blood from the small intestine. The https:// ensures that you are connecting to the Recommendations: It is strongly advised based on the findings of this study that Serum cobalamin levels should be measured in Type II diabetes patients who are Articles in Google Scholar by Amal N. Alshammari, Other articles in this journal by Amal N. Alshammari, Privacy Policy (Updated December 15, 2022). Because there is a possibility that taking vitamin B12 pills will not be the right choice for you. Vitamin B12 levels were checked in all the patients and value of 150 pmol/L was taken as normal. The average B12 level in the blood was 223pg/ml. There was no vitamin B12 deficiency in 53 (45.4%) of the patients. The prevalence of vitamin B12 deficiency was 6.6%. Metformin; type 2 diabetes; Vitamin B12 deficiency; Vitamin B12 screening; Vitamin B12 supplementation. The mean HbA1c for all patients was 8.45 2.01% (range: 4.2316.0). Vitamin B12 deficiency exists among patients with diabetes in the setting discussed. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. We conducted a cross-sectional study among patients attending Princess Marina diabetes clinic in Gaborone between July 2017 and October 2017. Instead of lowering blood glucose levels, the level of vitamin B12 gets lowered itself in diabetic patients. Many such vitamin B12 rich foods can be obtained from animal and non-animal sources. The first possible treatment option is to look at your diet. Diabetic patients should choose a diet that contains B12, else they will face a severe deficiency of this vitamin. 2016;17:44, 21. The most commonly used oral hypoglycemic agent was gliclizide only in 138 (38.4%) of patients. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. Michalak SS, Wolny-Rokicka E, Nowakowska E, Michalak M, Gil L. J Diabetes Res. The use of vitamin B12 supplement was significant among patients 46 years old and above [Table 4]. A linear regression model was used to evaluate variables that correlated with vitamin B12 levels and diabetic neuropathy. Register to receive personalised research and resources by email. privacy practices. -, Ko SH, Ko SH, Ahn YB, Song KH, Han KD, Park YM, Ko SH, Kim HS. 3099067 Recommendations for Practical Use of Metformin, a Central Pharmacological Therapy in Type 2 Diabetes. 2022 Mar 16;58(3):430. doi: 10.3390/medicina58030430. Estimation of Serum Vitamin B12 Levels Among the Elderly Population of Wardha City: A Cross-Sectional Study. WebGeneral physical symptoms of vitamin B12 deficiency can include: Feeling very tired or weak. Unable to load your collection due to an error, Unable to load your delegates due to an error. Several studies have unequivocally demonstrated that vitamin B12 deficiency is highly prevalent in adult diabetic patients [24]. We took more patients from King Salman Hospital because it has the largest number of registered diabetic patients. 5 Howick Place | London | SW1P 1WG. 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. Those taking a higher metformin dose had lower levels of vitamin B12 (coefficient: -0.061; CI 95%: -0.09, -0.024). [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. Fuchs HE, O'Connell K, Du M, Navarro SL, Brasky TM, Kantor ED. 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. Causes and pathophysiology of vitamin B12 and folate deficiencies. It depicts that vitamin B12 absorption is a calcium-dependent process. We recommend screening and treating vitamin B12 deficiency in patients with diabetes who are on long-term metformin and acid blockers. Acid ( MMA ), lansoprazole ( Prevacid ) or and transmitted securely for you appointments! 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