https://www.micromedexsolutions.com. A p-value of less than 0.05 was considered significant. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. J. Clin. Routine testing for serum vitamin B12 level is not practiced in our institution. The NTSS-6 questionnaire was the only tool used to assess peripheral neuropathy. Before Vitamin B-12 supplements also are recommended for women who are pregnant or breastfeeding exclusively and follow vegetarian or vegan diets. Rodrguez-Gutirrez R, Montes-Villarreal J, Rodrguez-Velver K, Gonzlez-Velzquez C, Salcido Montenegro A, Elizondo-Plazas A, et al Metformin use and Vitamin B12 deficiency: Untangling the association Am J Med Sci. Diabetes Obes Metab. Metab., 101 (2016), pp. Al Dawish MA, Robert AA, Braham R, Al Hayek AA, Al Saeed A, Ahmed RA, et al Diabetes mellitus in Saudi Arabia: A review of the recent literature Curr Diabetes Rev. The recommended daily amount of vitamin B-12 for adults is 2.4 micrograms. 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]. Metformin associated B12 deficiency J Assoc Physicians India. 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. 2016;42:31627, 15. Cochrane Database Syst Rev. Unlike diabetes type 1, diabetic patients with type 2 diabetes have a 10% more risk of getting its deficiency. A multi-cluster random sampling technique was used. Bethesda, MD 20894, Web Policies [2] The prevalence of diabetes in Saudi Arabia alone has increased to reach 7 million cases. 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). A lack of vitamin B12 leads to anaemia and sometimes to other problems. [30] Metformin causes gastrointestinal disturbances when started at a higher dose and with long-term use through competitive inhibition or inactivation of Cb1 absorption, alterations in the intrinsic factor levels, interactions with the cubulin endocytic receptor, and antagonism of the calcium-dependent ileal membrane. 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. Vitamin B12 levels were measured by chemiluminescence immunoassay. 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. Adults with type 2 diabetes and low levels of vitamin B12 could be more likely to experience cardiovascular autonomic neuropathy (CAN), according to new findings. Vitamin supplementation in disease prevention. 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. WebVitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. Aims To compare the prevalence of vitamin B12 deficiency and peripheral neuropathy between two groups of type 2 diabetes mellitus (T2DM) patients treated with or without metformin, and to determine factors associated with vitamin B12 deficiency therapy and dietary intake of vitamin B12. It is believed that malabsorption of vitamin B 12 in diabetic patients, is due to individuals taking metformin therapy per ml You can control blood glucose level in your body by increasing intake of vitamin B12. modify the keyword list to augment your search. 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]. Careers. In addition, female patients had higher levels of vitamin B12 compared to men (coefficient: 49.1; CI 95%: 2.3-95). BMJ 2010. c2181. You can obtain it through meat, poultry, fish, and dairy products. Vitamin B12 deficiency was defined as serum levels less than 148 pmol/L or 200 pg/mL.[24]. 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). Weight The average B12 level in the blood was 223pg/ml. Some people are vegetarian or vegan and dont eat animal products at all. 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. Kancherla V, Elliott J, Patel B, Holland N, Johnson T, Khakharia A, et al Long-term metformin therapy and monitoring for Vitamin B12 deficiency among older veterans J Am Geriatr Soc. 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. There were 39 diabetic patients, 16 took metformin for at least 1 year. SAGE Open Med. Journal of Family Medicine and Primary Care8(7):2306-2311, July 2019. To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. -. Proactively addressing the risk of developing low vitamin B 12 levels in this patient population not only reduces potential physical and mental sequelae but also lessens the financial burden of disease, appointments, testing, loss of 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. Mellitus Diabetic patients can easily develop a B12 deficiency as they are at a higher risk. WebConclusion: The prevalence of vitamin B12 deficiency is considerable among diabetic patients on metformin therapy. Epub 2022 May 20. Clipboard, Search History, and several other advanced features are temporarily unavailable. An official website of the United States government. A cross-sectional study was conducted with 162 patients. Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. If it remains unchecked, you will also experience symptoms of peripheral neuropathy in diabetic neuropathy. Unauthorized use of these marks is strictly prohibited. Besides an imbalance diet, undersupply of IF (Intrinsic Factor) protein also causes vitamin B12 deficiency. Keywords: Office of Dietary Supplements. The first thing you should keep in mind while treating vitamin B12 deficiency is to act upon a doctors prescription. 2006;35:2001, 6. Also, add a good amount of green leafy vegetables to your diet. Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. 2016;134:4739, 22. 2014;29:1394400, 18. 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. Accessed Jan. 9, 2021. 2003;(4):CD004514. Table 2: Factors associated with Vitamin B12 deficiency among patients with diabetes at Princess Marina Hospital diabetes clinic, between July 2017 and October 2017. The use of vitamin B12 supplement was significant among patients who were 46 years old and above. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. [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. 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. Comparison of Patients Receiving Long-Term Metformin Therapy and Vitamin B. 2014;127:816, 23. The worldwide prevalence of diabetes is high including Saudi Arabia. Low vitamin B12 levels can worsen some symptoms of Parkinson's disease, especially postural instability and cognitive impairment, which can lead to falls and injuries, researchers say.Lower vitamin B12 levels also are associated with higher Hoehn-Yahr stage, the tool for assessing disease severity, and neuropathy in PN was significantly associated with female gender and poor glycemic control and was not associated vitamin B12 deficiency or metformin use. official website and that any information you provide is encrypted Background: Type 2 diabetes mellitus is associated with vitamin B12 deficiency which is further increased in patients who are on metformin therapy. Articles in Google Scholar by Amal N. Alshammari, Other articles in this journal by Amal N. Alshammari, Privacy Policy (Updated December 15, 2022). 2013;71:38690, 12. E-mail: [emailprotected]. 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. 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. It presents with diverse clinical manifestations ranging from impaired memory, dementia, delirium, peripheral neuropathy, sub acute combined degeneration of the spinal cord, megaloblastic anemia and pancytopenia. WebLong-term low vitamin B12 levels caused by pernicious anemia can affect your nervous system. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. At the same time, its better to use natural dietary fibers like foods rich in vitamin B12. 1 The prevalence of vitamin B12 deficiency in diabetes mellitus 2016 Nov;42(5):316-327. doi: 10.1016/j.diabet.2016.03.008. Sample size was calculated using the formula (N = 4 pq/d2, where N is the sample size, P is the expected population, q = 1-p, and d as the precision. [1415161718] Furthermore, there were several studies that quantified the prevalence of vitamin B12 deficiency among diabetics including the 7% prevalence in a US study,[19] 28.1% prevalence in a South African study,[20] 22.5% in Brazil,[21] 18.7% in New Zealand,[22] 9.7% in the Netherlands,[7] and 9.7% in Libya. Results About 29.66% of diabetic patients had confirmed the B12 insufficiency through laboratory tests. BMC Pharmacol Toxicol. -Chronic treatment should be done with an oral preparation in patients with normal intestinal absorption. 2022 Mar 16;58(3):430. doi: 10.3390/medicina58030430. Diabetes patients are often exposed to metformin, as it is an oral medication for hyperglycemia. Foods fortified with vitamin B12, such as breakfast cereals, bread, tofu, and nutritional yeast, are fortified. Vitamin B12 deficiency due to metformin occurs because it interferes with the complex of B12-IF. 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). The data collection was done in the clinic using a data extraction form. Epub 2015 Aug 2. 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. Owhin SO, Adaja TM, Fasipe OJ, Akhideno PE, Kalejaiye OO, Kehinde MO. CAN occurs when nerve damage affects the heart, which can be caused by prolonged hyperglycemia over several years in people with diabetes. PMC Encephale. People usually take this vitamin along with folate and other vitamin B complexes. Approval was taken from and approved by the Institutional Review Board of MoH. Would you like email updates of new search results? In most cases, this depletion takes place 3 to 4 months after starting this therapy. 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. [23], Vitamin B12 deficiency screening is recommended for diabetic patients on long-term treatment with biguanides including metformin. Vitamin B12 deficiency was defined by levels < 150pmol/l. J Pak Med Assoc. [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]. When it comes to increasing the level of vitamins for diabetes, people usually take supplements. While in anemia, the number of healthy red blood cells to carry out oxygen depletes. Aust Fam Physician. Recommendations for Practical Use of Metformin, a Central Pharmacological Therapy in Type 2 Diabetes. Accessed Jan. 9, 2021. 2009;22:52834, 8. to maintaining your privacy and will not share your personal information without 2022 Jan;40(1):97-107. doi: 10.2337/cd21-0043. 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. WebVitamin B 12 deficiency, (IR) and those without. So, consult with your doctor if you are at high risk or have any of the symptoms. The site is secure. 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. We recommend screening and treating vitamin B12 deficiency in patients with diabetes who are on long-term metformin and acid blockers. 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. 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). 2022 Aug 20;14(8):e28194. Even though it has known efficacy and favorable safety profile, there are reported side effects such as vitamin B12 malabsorption. J Pharm Technol. The use of acid blockers was also associated with vitamin B12 deficiency (p=0.012). -, Ko SH, Ko SH, Ahn YB, Song KH, Han KD, Park YM, Ko SH, Kim HS. 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. The cumulative dose of metformin during the study period is not an accurate reflection of the dose taken/compliance as a pill count (counting returned tablets) or prescription filling was not correlated, and hence the resultsshowing no significant difference between the sufficient and deficient B12 groupsshould be interpreted with caution. Cited by lists all citing articles based on Crossref citations.Articles with the Crossref icon will open in a new tab. These can include dementia, disorientation, neurological damage, gait disturbance and anemia. Fuchs HE, O'Connell K, Du M, Navarro SL, Brasky TM, Kantor ED. Though vitamin B12 is commonly taken to increase energy levels, evidence showing that B12 supplements improve energy levels in people without a deficiency is lacking. 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 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. [24] Although vitamin B12 deficiency is a common but not serious condition, it is deemed important to treat patients to avoid neurological impairment even if there may be discordance between the results and clinical features. 2017;354:16571, 19. (10.1007/bf00427979) Low vitamin B12 levels were found in 7.3% (95% CI: 4.0-12%) of patients. We took more patients from King Salman Hospital because it has the largest number of registered diabetic patients. Table 1 shows the clinicodemographic profile of all patients. 5 Howick Place | London | SW1P 1WG. Certain drugs may lead to World J Diabetes. [4] Both American and European guidelines recommend metformin as the first-line agent for the pharmacological management of T2DM. may email you for journal alerts and information, but is committed Metformin and vitamin B12 deficiency: where do we stand? The mean HbA1c for all patients was 8.45 2.01% (range: 4.2316.0). Data is temporarily unavailable. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. 3- Medications of peptic ulcer and acid reflux disorder including Omeprazole (Prilosec), Famotidine (Pepcid AC), Ranitidine (Zantaz), and Lansoprazole (Prevacid). Some error has occurred while processing your request. Folic acid with or without vitamin B12 for cognition and dementia. There were only 16 patients (4.4%) who had available serum vitamin B12 levels. 2016;59:42635, 30. Please enable it to take advantage of the complete set of features! One such major complication is damage to nerves due to very high blood glucose levels for a long period. Your message has been successfully sent to your colleague. Leung S, Mattman A, Snyder F, Kassam R, Meneilly G, Nexo E. Metformin induces reductions in plasma cobalamin and haptocorrin bound cobalamin levels in elderly diabetic patients Clin Biochem. The tool is prone to subjectivity as it is symptom dependent, and there is a possibility of misclassification of participants. Register to receive personalised research and resources by email. Wolters Kluwer Health However, our findings should be interpreted while considering several limitations. WebVitamin B12 deficiency is related to a number of comorbidities, such as peripheral neuropathy and megaloblastic anemia. 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). According to research studies, nearly 30 percent of diabetic patients suffer less vitamin B12 absorption in their intestines. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional. Of all the patients 17 were already considered to be deficient in B12. 2- Metformin containing Glumetza and Glucophage for treatment of diabetes type 2. If you are a Mayo Clinic patient, this could To estimate the prevalence of Vitamin B12 deficiency among patients with diabetes. Patients on metformin therapy and vitamin B only tool used to assess peripheral neuropathy and megaloblastic anemia symptoms... ) protein also causes vitamin B12 deficiency among patients who were 46 years old and above to!:2306-2311, July 2019 were 39 diabetic patients on long-term metformin and B12... And Glucophage for treatment of diabetes type 1, diabetic patients can easily develop a deficiency... Eat animal products at all confirmed the B12 insufficiency through laboratory tests including metformin far as you. B12 leads to anaemia and sometimes to other problems register to receive personalised research resources. The use of acid blockers cases, this could to estimate the prevalence of is! 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