An Investigation on Vitamin B12 Serum Levels among Type 2 Diabetic Patients Treated with Metformin Compared to Normal Levels (original) (raw)
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Evaluation of Serum Vitamin B12 Levels in Type 2 Diabetes Patients Metformin Treated
Revista de Chimie, 2018
Vitamin B12 deficiency is a condition characterized by neurological or haematological abnormalities, and may occur after treatment with metformin in patients with type 2 diabetes. We evaluated 119 patients with type 2 diabetes mellitus, treated with oral antidiabetic agents. The parameters evaluated were: vitamin B12 intake, anthropometric data, disease history, neuropathic complications evaluation (using MNSI), serum vitamin B12, glycated hemoglobin, erythrocyte indices. Vitamin B12 deficiency was defined at values below 194 pg/mL. We have found a prevalence of vitamin B12 deficiency of 13.9% in the patients treated with metformin (10.9% in all participants). B12 levels were not correlated with age, metformin dose or duration of treatment. Patients using B12 supplements had higher B12 serum levels (472.50 vs. 329.22, p � 0.05).
International Journal of Advances in Medicine, 2016
Background: Type 2 diabetes mellitus is associated with vitamin B12 deficiency which is further increased in patients who are on metformin therapy. 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 not on metformin. Methods: The study was a hospital based, case control type of analytical study conducted in SMS Medical College & Hospital, Jaipur during a period of 1 year. The study group has 50 patients with a diagnosis of T2DM and a prescription history of metformin for ≥18 months and control group has 50 patients with diagnosis of T2DM and no history of metformin use in the past five years. The following data was recorded for each patient: age, sex, weight, height, body mass index (BMI), years with diabetes, total daily dose of and years on metformin. Serum vitamin B12 was measured using an immunoassay method. Data were statistically analyzed. Results: Mean serum vitamin B12 levels in the study group was 431.84±265.76 and in control was 744.76±271.927 and the difference was statistically significant. Mean serum vitamin B12 levels in vegetarians (547.27±303.011) were significantly lower than in non-vegetarian (699.22±307.992) (p value 0.029). A significant negative correlation existed between the S. vitamin B12 and duration of diabetes (r=-0.445) by using Pearson's correlation coefficient in study group. Conclusions: Metformin is significantly associated with decrease in vitamin B12. So we recommend that vitamin B12 should be measured prior to initiation of metformin therapy and later annually in patients of type 2 diabetes mellitus who are on metformin therapy for long duration (≥3-4 years) or in higher doses (≥2gm/day).
Asian Journal of Medical Research, 2019
Background: Diabetes is fast gaining the status of a potential epidemic in India, with more than 62 million diabetic individuals currently diagnosed with the disease. Subjects and Methods: 50, Type-2 diabetic patients on metformin therapy, with age ranging from 30 to 65 years and 50 healthy controls, were recruited from the General Medicine Department of Nimra Institute of Medical Sciences, according to inclusion and exclusion criteria. Results: In this study, the level of FBS, HbA1c, Fasting insulin, Homocysteine, C peptide, and Methyl Malonic acid were significantly increased (p <0.01), while Vitamin B12 levels were significantly decreased (p<0.01) in the study group, as compared to controls. It was observed that the mean level of vitamin B12 markers, homocysteine and methylmalonic acid were significantly higher and low level of vitamin B12 was found in patients who were on metformin therapy. Reports have shown that metformin use has a significant impact on the concentration of vitamin B12 in patients with T2DM.Conclusion: Metformin, which is the first line oral hypoglycemic agent as recommended by ADA, is significantly associated with decrease in vitamin B12 levels. There is moderate correlation between the markers of B12 status and levels of fasting blood sugar as well as HbA1C. There is a significant correlation between insulin and C-peptide with the markers of vitamin B12 status.
Vitamin B12 in type 2 diabetic patients treated with metformin
Endocrinología y Nutrición (English Edition), 2012
Objective: To test vitamin B 12 plasma levels in type 2 diabetic patients treated with metformin in our area. Methods: A cross-sectional, observational study of consecutive type 2 diabetic patients on drug treatment attending an internal medicine outpatient clinic. Results: One hundred and nine patients (81 treated with metformin) were enrolled into the study. Mean time on metformin treatment was 43.5 months and mean drug dose was 1779 mg/day. Patients treated with metformin had significantly lower vitamin B 12 plasma levels (393.5 vs 509 pg/mL, p = 0.0008). Seven (8.6%) of 81 patients treated with metformin and none of the 28 patients not treated with the drug had vitamin B 12 plasma levels lower than 197 pg/mL. No correlation was found between vitamin B 12 plasma levels and metformin treatment time or dosage. Conclusions: In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B 12 plasma levels. Vitamin B 12 deficiency associated with metformin is relatively common in our area.
Association Of Vitamin B12 Deficiency With Intake Of Oral Metformin In Diabetic Patients
Journal of Ayub Medical College, Abbottabad : JAMC, 2019
BACKGROUND It is estimated that 450 million people worldwide have diabetes mellitus Objective of the study was to determine effect of Metformin on vitamin B12 level among patients with type 2 diabetes mellitus. It is a cross sectional study conducted at Medicine department, Shalamar Hospital Lahore. METHODS Seventy-two patients of diabetes mellitus were included in the study. All patients who could have any other disease process that can lead to Vitamin B12 deficiency were excluded from the study. They were segregated into two groups, first one was getting metformin for the last 2 years and the second group was not taking metformin. Vitamin B12 levels were checked in all the patients and value of 150 pmol/L was taken as normal. RESULTS Out of 72 patients who participated in our study, 40 patients (55.5%) were taking metformin for more than two years while 32 patients (44.5%) were not taking metformin for the last two years. Mean age of patients taking metformin and not taking metfor...
Status of Serum Vitamin B12 in Type 2 Diabetes Mellitus Patients under Metformin Therapy
Nepal Journal of Health Sciences
Introduction: Type 2 diabetes mellitus, a prevalent global health problem, is a major cause of morbidity and mortality. Metformin, the most widely used hypoglycemic agent can lead to a deficiency of vitamin B12. Very less information is available regarding the relationship between metformin therapy and vitamin B12 deficiency in the Nepalese population. Objectives: The study aims to evaluate the level of vitamin B12 in cases of diabetes mellitus under metformin therapy and to access the relationship of serum vitamin B12 level with the duration of metformin therapy. Methods: A hospital-based cross-sectional study with 300 diagnosed diabetes mellitus cases under metformin therapy were enrolled in the study after the consent was taken. The prior ethical clearance was taken and the duration of the study was from December 2021 to June 2022. Results: The study showed 78% (n=234) of the total diabetic cases under metformin therapy had lower vitamin B12. In 50-60 years, age group, 91% of the...
Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND Type 2 Diabetes Mellitus (T2DM) is an endocrine disorder and a heterogeneous group of syndromes characterised by an elevation of fasting blood glucose that is caused by a relative or absolute deficiency in insulin. Serum vitamin B12 levels have been reported to be inversely associated with the dose and duration of metformin use. Vitamin B12 deficiency is a treatable condition. However, there is insufficient data regarding prevalence of vitamin B12 deficiency in the South Indian population. Hence, the study was undertaken to evaluate serum vitamin B12 levels in T2DM on metformin therapy. MATERIALS AND METHODS A total of 100 T2DM patients attending Outpatient Department (OPD) or admitted under Department of General Medicine of KIMS, Hubli, during the time period of 2 years were taken for study considering the inclusion and exclusion criteria. Qualifying patients underwent detailed history, clinical examination, routine investigation and vitamin B12 estimation. RESULTS Majority were in the age group of 45-59 years making 42% of the total. The age group in most patients having vitamin B12 deficiency was >60 years. Males had more vitamin B12 deficiency forming 54.5%. Vitamin B12 deficiency was more in hypertensive group accounting for 71.4%, which was statistically significant. Most of the vitamin B12 deficiency patients had diabetes duration >10 years. Most of the vitamin B12 deficient patients were taking metformin therapy for longer years (≥10 years) and in higher dose (>2 g/day). Most of the vitamin B12 deficient diabetes patients were overweight forming 52.5% of the total. CONCLUSION Longer duration of diabetes increases the risk of developing vitamin B12 deficiency on metformin therapy. The higher dose of metformin intake had inverse relation with vitamin B12 levels. Longer duration of metformin intake causes vitamin B12 deficiency and hence should be screened for vitamin B12 deficiency and can be supplemented with vitamin B12.
Evaluation of Vitamin B12 status in type 2 Diabetes Mellitus Patients on Metformin therapy
Asian Journal of Medical Sciences
Background: B12 deficiency is a silent epidemic with serious consequences. Long term use of metformin has been associated with malabsorption of vitamin B12 leading to its deficiency along with increased homocysteine levels. With this background we designed this study to assess the status of vitamin B12 and its markers in type 2 diabetes mellitus patients on metformin therapy who are attending tertiary care hospital in the peripheral area of Pondicherry.Aims and Objective: The current study aims to study the relationship if any, between the glycemic status and the status of Vitamin B12 among T2DM patients on metformin therapy.Materials and Methods: A case control study was done with a sample size of 100 (50 case and 50 control). The patients were selected according to the inclusion criteria and their blood sample were analyzed for the various parameters. The markers of vitamin B12 status are studied among both the control and the patients with T2DM on metformin therapy and compared w...
Review for the management of vitamin B12 deficiency in diabetic patients on metformin
International Journal of Research in Medical Sciences, 2020
Long-term usage of Metformin is associated with lower serum vitamin B12 levels. The lower than normal levels could worsen neurological complications of diabetes, including diabetic neuropathy and poor cognition. Guidelines advise periodic monitoring of vitamin B12 but do not specify frequency, treatment targets or treatment modality. This commentary aims to review the prevalence and the severity of the presentation and to provide evidence-based answers to those clinical questions not answered by current guidelines.
Metformin Induced Vitamin B12 Deficiency among Type 2 Diabetes Mellitus Patients
Indian Journal of Pharmacy Practice, 2019
Metformin is the most frequently prescribed medication in the management of Type 2 Diabetes Mellitus. It is widely approved that it suppresses hepatic glucose production and improves insulin signalling mainly in muscle, hepatic and adipose tissue. On long term use, metformin therapy leads to Vitamin B 12 deficiency and anemia. Several studies shows that long term metformin use reduce the Vitamin B 12 levels and particularly taken in a dose greater than 2000 mg/day and for a period exceeding 4 years. The prevalence is increased with increase in dose and duration of metformin use. Peripheral neuropathy may be the only clinical presentation of Vitamin B 12 deficiency, without haematological signs and symptoms. The diagnostic tests like serum Vitamin B 12 and holo-TC-11 test measure the circulating part of Vitamin while homocysteine and MMA are the biomarkers of metabolic Vitamin B 12 deficiency that show elevated levels when the Vitamin is deficient at the cellular level. Currently there are no guidelines for the supplementation and appropriate dose of Vitamin B 12 for diabetic patients on metformin but the treatment of Vitamin B 12 deficiency includes monthly injections of Vitamin B 12 or large daily therapeutic doses (1000mcg) of Vitamin B 12 , prophylactically administered calcium carbonate (1.2gms daily). This article demonstrates that regular monitoring of Vitamin B 12 should be done especially in patients receiving metformin therapy for longer duration at high dosage and Vitamin B 12 supplementation prophylactically or at least annually to prevent the complications of Vitamin B 12 deficiency.