Metformin and the gastrointestinal tract Diabetologia. Additional data, including demographic characteristics were collected. So, it was not possible to get a valid estimate of the deficiency prevalence. Did you know that with a free Taylor & Francis Online account you can gain access to the following benefits? the unsubscribe link in the e-mail. The data collection was done in the clinic using a data extraction form. 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. 2- Metformin containing Glumetza and Glucophage for treatment of diabetes type 2. 2017;65:10616, 20. Diabetes mellitus (DM) is a chronic metabolic disease with increasing prevalence worldwide. You may also suffer from diabetic neuropathy due to a lack of vitamin B12. Metformin Treatment: A Potential Cause of Megaloblastic Anemia in Patients with Type 2 Diabetes Mellitus. Older adults and people with digestive tract conditions that affect absorption of nutrients also are susceptible to vitamin B-12 deficiency. Causes and pathophysiology of vitamin B12 and folate deficiencies. The duration of T2DM and duration of metformin use was significantly longer among females (p = 0.025 and P = 0.018, respectively) [Table 3]. 2016;17:44, 21. Its due to metformin therapy that boosts vitamin B12 depletion in the human body. 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. Accessed Jan. 9, 2021. Not feeling as hungry as usual. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. 2011;57:469, 11. de Groot-Kamphuis DM, van Dijk PR, Groenier KH, Houweling ST, Bilo HJ, Kleefstra N. Vitamin B12 deficiency and the lack of its consequences in type 2 diabetes patients using metformin Neth J Med. 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. Diabetologia 1969. Albai O, Timar B, Paun DL, Sima A, Roman D, Timar R. Diabetes Metab Syndr Obes. Irritability. Vitamin B12: Fact sheet for professionals. In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. 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. 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. 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. Vitamin B-12 is an essential vitamin for diabetes patients as it promotes healthy blood cells and nervous system. General multivitamins (6 g) was found to be not enough to correct vitamin B12 deficiency particularly among those with diabetes.[8]. Natural Medicines. 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. Instead of lowering blood glucose levels, the level of vitamin B12 gets lowered itself in diabetic patients. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. 2012;35:32733, 9. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. Diabetes: Fact sheet [Internet]. Results About 29.66% of diabetic patients had confirmed the B12 insufficiency through laboratory tests. The tool is prone to subjectivity as it is symptom dependent, and there is a possibility of misclassification of participants. Vitamin B12 deficiency is then easily missed. eCollection 2019. eCollection 2020. To provide you with the most relevant and helpful information, and understand which It was thought that the use of PPI contributes to vitamin B12 deficiency,[32] which may add to the vitamin B12 deficiency status of T2DM patients. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. To make your body function smoothly, you should also take medications for the effective absorption of B12. [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. 2016;59:42635, 30. The mean daily dose of metformin was 984.85 320.96 mg (range: 5002000 mg). National Library of Medicine High doses of vitamin B-12, such as those used to treat a deficiency, might cause: Your doctor might recommend changing drugs or timing doses to offset any potential interactions. 8600 Rockville Pike 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). WebGeneral physical symptoms of vitamin B12 deficiency can include: Feeling very tired or weak. https://www.uptodate.com/contents/search. Mayo Clinic does not endorse companies or products. (10.2337/dc11-1582) Owhin SO, Adaja TM, Fasipe OJ, Akhideno PE, Kalejaiye OO, Kehinde MO. 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. 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. Sharma R, Wanjari MB, Raut A, Gujar S, Gledina A, Kantode VV, Munjewar PK. 2009;32:193203, 28. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. The mean duration of metformin use was 9.84 7.29 years (range: 1.035 years). On average, diabetic patients should take 300 mcg of biotin, 150 mcg of B12, 1.5 mg of B1, 75 mg of B6, 25 mg of B2, and 2.5 mg of folic acid. The use of acid blockers was also associated with vitamin B12 deficiency (p=0.012). Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine. If youre to maintaining your privacy and will not share your personal information without The questionnaire was piloted on five physicians to determine consistency and validity of the questionnaire. Vitamin B12 deficiency resulting from metformin use has been demonstrated in multiple studies. Accessibility ated type 2 diabetes mellitus patients. Vitamin B 12 deficiency associated with metformin is relatively common in our area. 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 .gov means its official. Severe deficiency (e.g., pernicious anemia) may lead to macrocytic anemia, peripheral neuropathy, and mental-psychiatric disorders [ 9, 10 ]. 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. If you face a serious problem maintaining glucose, taking a vitamin B12 injection for almost 3 months will help you bring things in balance. government site. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. official website and that any information you provide is encrypted Accessed Jan. 9, 2021. 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. Data is temporarily unavailable. (10.3346/jkms.2014.29.7.965) A large percentage of physicians are not aware of the current recommendations of the ADA regarding vitamin B12 supplementation and screening. A large percentage of physicians are not aware of the current recommendations of the American Diabetic Association (ADA) regarding vitamin B12 supplementation and screening. The recommended daily amount of vitamin B-12 for adults is 2.4 micrograms. Articles in Google Scholar by Amal N. Alshammari, Other articles in this journal by Amal N. Alshammari, Privacy Policy (Updated December 15, 2022). The only way to recover from your condition of hyperhomocysteinemia is by taking a regular dose of vitamin B12, vitamin B6, and folic acid. All data were entered and analysed using SPSS Statistics for Windows, Version 23.0 (IBM SPSS Statistics for Windows, Version 23.0 [IBM Corp, Armonk, NY, USA]). 1 The prevalence of vitamin B12 deficiency in diabetes mellitus By Jay Furst. This content does not have an English version. While in anemia, the number of healthy red blood cells to carry out oxygen depletes. 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. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. Most (89.5%) participants were on metformin. We conducted a cross-sectional study among patients attending Princess Marina diabetes clinic in Gaborone between July 2017 and October 2017. But prolonged vitamin B12 deficiency can also cause it. Michalak SS, Wolny-Rokicka E, Nowakowska E, Michalak M, Gil L. J Diabetes Res. An official website of the United States government. There were 107 patients (29.5%) who were on PPIs. Foods fortified with vitamin B12, such as breakfast cereals, bread, tofu, and nutritional yeast, are fortified. Vitamin B-12 injections or nasal spray might be prescribed to treat vitamin B-12 deficiency. Short-term memory loss. and transmitted securely. When taken at appropriate doses, vitamin B-12 supplements are generally considered safe. Some error has occurred while processing your request. Disclaimer. Diabetes Obes Metab. Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. Thus, there is a need for doctors involved in the management of diabetes to keep abreast with guidelines and current recommendations and routinely monitor vitamin B12 levels particularly those who were on long-term takers of metformin and the elderly patients to optimize management of diabetes and its complications. Table 1: Baseline characteristics of patients with diabetes at Princess Marina hospital diabetes clinic, between July 2017 and October 2017 (n=351). In short, the long-term deficiency of vitamin B12 causes serious symptoms like depression, delusion, difficulty in walking, loss of mobility, seizures, and dementia. There was no vitamin B12 deficiency in 53 Consult your doctor to analyze the blood sample report to assess the level of essential vitamins and minerals. WebVitamin B12 is a water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function. Vitamin B12 deficiency due to metformin occurs because it interferes with the complex of B12-IF. A skilled professional, Dr. Barnett holds certification from the American Board of Internal Medicine with a special focus on endocrinology, diabetes, and metabolism. 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. In a journal article on plant-based vitamin B12 sources, researchers have claimed that purple larval and mushrooms are very healthy and rich sources of B12. McCreight LJ, Bailey CJ, Pearson ER. Here are some main sources from which you can improve your diabetic condition: Animal source vitamin B12 rich foods are eggs, fish, poultry, meat (including lamb, pork, and beef), and dairy products (including cheese and milk), Non-animal sources of vitamin B12 are vegetables and plants, including Korean purple laver and mushrooms. WebA B12 supplement can be helpful if you have type 2 diabetes and are deficient in the vitamin. The most commonly used oral hypoglycemic agent was gliclizide only in 138 (38.4%) of patients. There were 205 patients 56.5% who had a daily dose of 750 mg of metformin. Of the 16 patients who had vitamin B12 levels, two (12.5%) had vitamin B12 level below 200 pg/mL. 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 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. 2012;60:5860, 32. Using metformin therapy for a long time is a cost-effective and practical treatment of blood glucose level maintenance. Those taking a higher metformin dose had lower levels of vitamin B12 (coefficient: -0.061; CI 95%: -0.09, -0.024). Journal of Korean Medical Science 2014. However, our findings should be interpreted while considering several limitations. Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. Treatment Of B12 Deficiency In Diabetes Patients. Ko SH, Ahn YB, Song KH, Han KD, Park YM, Kim HS. How common is vitamin B-12 deficiency? Please enable it to take advantage of the complete set of features! WebVitamin B12 deficiency is related to a number of comorbidities, such as peripheral neuropathy and megaloblastic anemia. Accessed Jan. 9, 2021. There were 39 diabetic patients, 16 took metformin for at least 1 year. Diabetes Metab. Long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. Haeusler S, Parry-Strong A, Krebs JD. Cyanocobalamin. Vitamin B12 deficiency in diabetic people is quite common. 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. 1754-1761, 10.1210/jc.2015 You might be thinking about how you can take vitamin B12 naturally when you are a vegetarian. A total of 6 of the 16 patients (37.5%) used PPI, and 11 (68.8%) had Vitamin B12 supplementation. Would you like email updates of new search results? Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. 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. health information, we will treat all of that information as protected health With a free Taylor & Francis Online account you can take vitamin B12 deficiency if you type. Driven recommendation engine related to a number of comorbidities, such as peripheral neuropathy and Megaloblastic anemia in with... You may also suffer from diabetic vitamin b12 deficiency in diabetic patients due to a lack of B12. 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