Endocrinol. All patients diagnosed with T2DM who were on metformin for at least 1 year were included in the study. Problems concentrating. doi: 10.7759/cureus.28194. We excluded pregnant women and those with partial or total gastrectomy, colectomy, inflammatory bowel diseases and pernicious anaemia. Comparison of Patients Receiving Long-Term Metformin Therapy and Vitamin B. Never take a supplement or injection at your own decision. J Pharm Technol. WebA B12 supplement can be helpful if you have type 2 diabetes and are deficient in the vitamin. 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. 2022;74(7):2373-2383. doi: 10.1080/01635581.2021.2007271. The use of vitamin B12 supplement, duration of T2DM and duration of metformin use was significantly higher among females. The first thing you should keep in mind while treating vitamin B12 deficiency is to act upon a doctors prescription. The overall median (IQR) HbA1c and haemoglobin were 7.4 (6.49.2) % and 3g/dl. Results: When vitamin B12 does not reach the small intestine, it will not be absorbed properly, causing vitamin B12 deficiency. 2021 Jul 9;12:711244. doi: 10.3389/fmicb.2021.711244. You may be trying to access this site from a secured browser on the server. 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. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. [2] The prevalence of diabetes in Saudi Arabia alone has increased to reach 7 million cases. 327333. FOIA The only way to recover from your condition of hyperhomocysteinemia is by taking a regular dose of vitamin B12, vitamin B6, and folic acid. 965972. 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]. 2014;127:816, 23. Unlike diabetes type 1, diabetic patients with type 2 diabetes have a 10% more risk of getting its deficiency. How common is vitamin B-12 deficiency? J. Clin. Bookshelf Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. 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. The mean daily dose of metformin was 984.85 320.96 mg (range: 5002000 mg). 3099067 2014;29:1394400, 17. There are various vitamins of group B which are effective in lowering blood sugar levels. MeSH Keywords: Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. Liu KW, Dai LK, Jean W. Metformin-related vitamin B12 deficiency Age Ageing. If you are suffering from an absorption problem, taking more vitamins will do nothing better for you. Niafar M, Hai F, Porhomayon J, Nader N. The role of metformin on vitamin B12 deficiency: A meta-analysis review Intern Emerg Med. The worldwide prevalence of diabetes is high including Saudi Arabia. Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. Diabetes Metab. Metformin associated B12 deficiency J Assoc Physicians India. There was no vitamin B12 deficiency in 53 (45.4%) of the patients. Its not only the vitamin B12 that we intake orally. 2008;89:693S6S, 29. IBM Micromedex. Vitamin B12 deficiency exists among patients with diabetes in the setting discussed. Several studies have unequivocally demonstrated that vitamin B12 deficiency is highly prevalent in adult diabetic patients [24]. Accessed Jan. 9, 2021. Taking omeprazole (Prilosec), lansoprazole (Prevacid) or In diabetes, blood glucose level goes low beyond a certain limit. https://www.micromedexsolutions.com. Would you like email updates of new search results? Subsequently, every fifth patient in the clinic attendees was selected until the days desired sample size was reached. 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. official website and that any information you provide is encrypted 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). The NTSS-6 questionnaire was the only tool used to assess peripheral neuropathy. Facts & Comparisons eAnswers. 2016;59:42635, 30. BMC Pharmacol Toxicol. Approvals were taken from the directors of the four hospitals prior to data collection. This is the first study to estimate the prevalence of vitamin B12 deficiency in a diabetes clinic in Botswana to the best of our knowledge. government site. [56] Reports have shown that vitamin B12 deficiency occurs in 5.830% of diabetic patients on long-term treatment with metformin. You can obtain it through meat, poultry, fish, and dairy products. The majority were females (67.2%) and those with type 2 diabetes (92.9%). 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. The best way to treat low-level of vitamin B12 is by excessive intake of fortified bread, cereals, eggs, and milk. McCreight LJ, Bailey CJ, Pearson ER. Under normal routine, stomach cells create this protein. Vitamin B12 deficiency was defined by levels < 150pmol/l. A total of 6 of the 16 patients (37.5%) used PPI, and 11 (68.8%) had Vitamin B12 supplementation. Delusions. Also, add a good amount of green leafy vegetables to your diet. 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. The recommended daily amount of vitamin B-12 for adults is 2.4 micrograms. 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. other information we have about you. However, people who follow a vegetarian or vegan diet might be prone to deficiency because plant foods don't contain vitamin B-12. 2012;19:936. The most commonly used oral hypoglycemic agent was gliclizide only in 138 (38.4%) of patients. sharing sensitive information, make sure youre on a federal A p-value of less than 0.05 was considered significant. Dr. Braden G. Barnett is an endocrinologist in Los Angeles, California and is affiliated with multiple hospitals in the area, includingKeck Medical Center of USCandUSC Norris Comprehensive Cancer Center. Table 2 shows factors associated with Vitamin B12 deficiency among diabetes patients at Princess Marina Hospital diabetes clinic on bivariate analyses. E-mail: [emailprotected]. Vitamin B12 level was lower in type 2 diabetic patients on metformin compared to those on other oral anti-diabetic drugs, but without significant deficiency. People usually take this vitamin along with folate and other vitamin B complexes. 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. [Figure 1] A total of 51 (51.0%) order vitamin B12 testing supplementation only if they have symptoms of neuropathy, 9 (9.0%) if patients have anemia, 19 (19.0%) routinely order vitamin B12 testing, and 21 (21.0%) never prescribe vitamin B12 to their patients [Figure 2]. We were not also able to draw a solid conclusion on the association of vitamin B12 deficiency with vitamin B12 supplementation since we do not have enough number of patients who had vitamin B12 levels. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Despite its effectiveness, you should consult your doctor after a couple of months for proper screening. A multi-cluster random sampling technique was used. 2017;354:16571, 19. 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 present study found no significant difference in the presence of neuropathy between those with normal and deficient vitamin B12 levels. 2022 Jan;40(1):97-107. doi: 10.2337/cd21-0043. 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. Results were expressed as numbers and percentages for categorical variables and as mean and standard deviation (SD) for continuous variables. However, it may lower vitamin B12 concentrations, which could have hematological or neurological implications. Fairfield KM. 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. We used a researcher-administered questionnaire to obtain information on patients age, sex, HIV status, diabetes type and diabetes duration. Vitamin B12 deficiency is common with increased age, long duration of metformin use and acid blockers. We took more patients from King Salman Hospital because it has the largest number of registered diabetic patients. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. All prospective diabetic patients were identified from the diabetic care clinic records including the Vitamin B12 levels. You may search for similar articles that contain these same keywords or you may
Vitamin B12 deficiency due to metformin occurs because it interferes with the complex of B12-IF. 1- Does vitamin B12 is crucial for lowering blood sugar? The mean duration of T2DM was 9.88 7.32 years (range: 135 years). 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. 69 Vitamin B12 deficiency could be a modifiable risk factor for neuropathy in those patients. Register to receive personalised research and resources by email. Federal government websites often end in .gov or .mil. Categorical variables appear as counts and percentages. Review/update the
In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. Routine testing for serum vitamin B12 level is not practiced in our institution. Thus, you can take an intramuscular injection to boost the absorption of vitamin B12 in the blood. Office of Dietary Supplements. 17541761. Objective: National Library of Medicine When you do not treat your vitamin B12 deficiency, you may face severe diabetic complications. He received his medical degree from University of Southern California and has been in practice around 8 years. 2- Is Vitamin B complex healthy for diabetic patients? Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et alAmerican Diabetes Association; European Association for Study of Diabetes. [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. When it comes to increasing the level of vitamins for diabetes, people usually take supplements. Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind. Vitamin B(12) deficiency associated with concomitant metformin and proton pump inhibitor use Diabetes Care. https://www.uptodate.com/contents/search. 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. There was no vitamin B12 deficiency in 53 (45.4%) of the patients. Methylcobalamin. Results About 29.66% of diabetic patients had confirmed the B12 insufficiency through laboratory tests. Of all the patients 17 were already considered to be deficient in B12. Fuchs HE, O'Connell K, Du M, Navarro SL, Brasky TM, Kantor ED. This outpatient cross-sectional study found 6.6% of patients with diabetes at Princess Marina Hospital diabetes clinic to be vitamin B12 deficient. the unsubscribe link in the e-mail. By Jay Furst. Associations between Vitamin B12 deficiency and age, duration of diabetes mellitus, duration of use and dosage of metformin, and use of PPIs or histamine H2 antagonists were determined using Pearson's correlation test. Ko SH, Ahn YB, Song KH, Han KD, Park YM, Kim HS. 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/. A lack of vitamin B12 leads to anaemia and sometimes to other problems. Top Warning Signs of B12 DeficiencyTiredness. If you often feel exhausted, regardless of how much sleep youve gotten or how much energy youve exerted, it could be a sign that your body is lacking Mood swings. Do you find yourself experiencing a variety of emotions throughout any given day? It may result in depression. Digestive issues. Inflammation of the mouth and tongue. Insomnia. More items Both are confounders for vitamin B12 deficiency as they are known to decrease the excretion rate of cyanocobalamin which could result in a higher serum level. Vitamin B12 deficiency resulting from metformin use has been demonstrated in multiple studies. 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. It is believed that malabsorption of vitamin B 12 in diabetic patients, is due to individuals taking metformin therapy per ml 1 The prevalence of vitamin B12 deficiency in diabetes mellitus Vitamin B-12 is an essential vitamin for diabetes patients as it promotes healthy blood cells and nervous system. Unable to load your collection due to an error, Unable to load your delegates due to an error. eCollection 2019. 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. Wolters Kluwer Health
Irritability. Such patients are also more vulnerable to pernicious Armenia. Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. Table 5 shows the demographic profile of the 100 respondents. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? A study shows that vitamin B12 increases due to the inductive effect of metformin by increasing calcium intake. An official website of the United States government. 2003;32:3834, 25. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. Damio C, Rodrigues A, Pinheiro M, Cruz Filho R, Cardoso G, Taboada G, et al Prevalence of vitamin B12 deficiency in type 2 diabetic patients using metformin: A cross-sectional study Sao Paulo Med J. Vitamin B-12 deficiency has potentially serious and sometimes irreversible complications if undiagnosed and untreated. Though all vegetables and plants dont have vitamin B12, there are still some plant-based sources. Accessed Jan. 9, 2021. Most (89.5%) participants were on metformin. To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. 2014;10:93102, 16. When IF binds with Vitamin B12, a vitamin B12-IF complex forms, this complex plays a vital role in the absorption of vitamin B12 in your body. There are some limitations of this current study. 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. The .gov means its official. The Steno Diabetes While the recommended daily amount of vitamin B-12 for adults is 2.4 micrograms, higher doses have been found to be safe. Standards of medical care in diabetes Diabetes Care. Recommendations for Practical Use of Metformin, a Central Pharmacological Therapy in Type 2 Diabetes. There was no vitamin B12 deficiency in 53 Diabetic neuropathy was evaluated by patient record, nerve conduction and Michigan test for the diagnosis of diabetic neuropathy. Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy South Med J. 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. Besides an imbalance diet, undersupply of IF (Intrinsic Factor) protein also causes vitamin B12 deficiency. The calculated sample size was 363. Foods fortified with vitamin B12, such as breakfast cereals, bread, tofu, and nutritional yeast, are fortified. Many such vitamin B12 rich foods can be obtained from animal and non-animal sources. Diabetes Care 2012. However, our findings should be interpreted while considering several limitations. Metformin therapy and assessment for vitamin B12 deficiency: is it necessary? 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. Compared with participants with normal Vitamin B12 levels, deficient participants were significantly older (64 vs. 56 years, p=0.014) and had a longer duration of metformin use (7 vs. 4 years, p=0.024). Metformin Treatment: A Potential Cause of Megaloblastic Anemia in Patients with Type 2 Diabetes Mellitus. -, Reinstatler L, Qi YP, Williamson RS, Garn JV, Oakley GP Jr. Association of biochemical B12 deficiency with metformin therapy and vitamin B12supplements: the National Health and Nutrition Examination Survey, 19992006. Better for you weba B12 supplement, duration of metformin was 984.85 320.96 mg ( range: 5002000 mg.! 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Are significantly lower in patients with type 2 diabetes ( 92.9 % ) participants were on metformin to collection... Factors associated with concomitant metformin and proton pump inhibitor use diabetes care an association to bear in while! Pernicious anaemia of diabetic patients the prevalence of diabetes in Saudi Arabia vitamin b12 deficiency in diabetic patients has increased to reach 7 million.! Considered significant the best way to treat low-level of vitamin B12 deficiency could be modifiable!