vitamin b12 deficiency in diabetic patients

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. Clinical Implications of the Coexistence of Anemia and Diabetes Mellitus in the Elderly Population. 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. Vitamin B12 deficiency is both underdiagnosed and undertreated [ 7, 8 ]. . These can include dementia, disorientation, neurological damage, gait disturbance and anemia. 965972. 5 Howick Place | London | SW1P 1WG. Albai O, Timar B, Paun DL, Sima A, Roman D, Timar R. Diabetes Metab Syndr Obes. While in anemia, the number of healthy red blood cells to carry out oxygen depletes. Their mean daily dose of metformin was 828.13 150.52 mg (range of 5001000 mg). Vitamin B-12 supplements also are recommended for women who are pregnant or breastfeeding exclusively and follow vegetarian or vegan diets. 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. In those with diabetic neuropathy, altered (low and borderline) vitamin B12 level was 64% (95% CI: 47-78%) compared to 17% (95% CI: 10-26%) in patients without diabetic neuropathy (coefficient: -110.8; CI 95%: -165.8, -59.7). Using metformin therapy for a long time is a cost-effective and practical treatment of blood glucose level maintenance. The clinic has been operational since 2011 as a referral centre for health facilities in Gaborone and nearby towns. People with diabetes taking metformin are at a higher risk of developing B12 deficiency, because this medication can reduce vitamin B12 absorption in the body . It said: A paired t-test showed that in group A [the group given B12], patients with vitamin B12 Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Older adults and people with digestive tract conditions that affect absorption of nutrients also are susceptible to vitamin B-12 deficiency. Under normal routine, stomach cells create this protein. 2016;42:31627, 15. We assessed vitamin B12 status using serum vitamin B12 levels. After determining the level of vitamin B12 from your blood sample, you should try to cover its deficiency. To provide you with the most relevant and helpful information, and understand which 2012;60:5860, 32. The most commonly used oral hypoglycemic agent was gliclizide only in 138 (38.4%) of patients. Antiparietal cell antibodies occur in 90% of patients with pernicious anemia but in only 5% of healthy adults. Causes and pathophysiology of vitamin B12 and folate deficiencies. WebA B12 supplement can be helpful if you have type 2 diabetes and are deficient in the vitamin. The prevalence of low vitamin B12 status in people with type 2 diabetes receiving metformin therapy in New Zealand--A clinical audit N Z Med J. The mean duration of T2DM was 9.88 7.32 years (range: 135 years). 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). 2021 Oct 18;2021:8745968. doi: 10.1155/2021/8745968. Treatment Of B12 Deficiency In Diabetes Patients. 2017;9:725, 24. Conclusions: Keywords: Cobalamin Diabetes mellitus Metformin 1754-1761, 10.1210/jc.2015 Advertising revenue supports our not-for-profit mission. How common is vitamin B-12 deficiency? Severe deficiency (e.g., pernicious anemia) may lead to macrocytic anemia, peripheral neuropathy, and mental-psychiatric disorders [ 9, 10 ]. 2019 May 23;7:2050312119853433. doi: 10.1177/2050312119853433. This site needs JavaScript to work properly. WebLong-term low vitamin B12 levels caused by pernicious anemia can affect your nervous system. Methods In this retrospective study, we recruited 412 Proton pump inhibitors. Curr Diab Rep. 2021 Aug 27;21(9):31. doi: 10.1007/s11892-021-01397-1. Liu KW, Dai LK, Jean W. Metformin-related vitamin B12 deficiency Age Ageing. In this study, we aimed to evaluate the prevalence of vitamin B12 deficiency in patients with chronic metformin use and the relationship between vitamin B12 deficiency and diabetic neuropathy. 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. He received his medical degree from University of Southern California and has been in practice around 8 years. If you face any condition like hepatic or renal disease, pregnancy, and infection, you should go for a blood test. Lets discuss vitamin B12 deficiency, its reasons, and why its deficiency is serious for diabetes patients. Vitamin supplementation in disease prevention. 4 How long do vitamin B12 supplements take to work for diabetes treatment? Mayo Clinic does not endorse companies or products. 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. The use of vitamin B12 supplement was significantly higher among females (p < 0.001). J Pharm Technol. 2014;349:g5226, 26. 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. Endocrinol. Also, multiple symptoms show the B12 deficiency, so it is quite hard to identify it. Some error has occurred while processing your request. (10.3346/jkms.2014.29.7.965) The prevalence of vitamin B12 deficiency in patients with type 2 diabetes: a cross-sectional study, Association of biochemical B12 deficiency with metformin therapy and vitamin B12 supplements: the national health and nutrition examination survey, 19992006. People who take metformin for type 2 diabetes have lower levels of vitamin B12. -, 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. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Means RT Jr, et al. 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. 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. 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. 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. 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]. American Diabetes Association. Bookshelf Taylor & Francis does not sell reprints or permissions for this article. Conclusions In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B 12 plasma levels. 2017;354:16571, 19. -Chronic treatment should be done with an oral preparation in patients with normal intestinal absorption. In both diabetes type 1 and type 2, diabetic patients experience its deficiency. The mean HbA1c for all patients was 8.45 2.01% (range: 4.2316.0). Kumthekar AA, Gidwani HV, Kumthekar AB. Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine. So, it was not possible to get a valid estimate of the deficiency prevalence. [2] The prevalence of diabetes in Saudi Arabia alone has increased to reach 7 million cases. Consult your doctor to analyze the blood sample report to assess the level of essential vitamins and minerals. Cochrane Database Syst Rev. 2014;127:816, 23. Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. Vitamin B12 deficiency among adult diabetic patients in Uganda: relation to glycaemic control and haemoglobin concentration, Food consumption changes in Botswana since 1966, Influence of duration and dose of metformin on cobalamin deficiency in type 2 diabetes patients using metformin, Association of vitamin B12 and metformin in type II diabetes patients in Bahrain, An update on vitamin B12-related gene polymorphisms and B12 status, B-vitamins, genotype and disease causality: symposium on genetic polymorphisms and disease risk, Vitamin B 12 levels in patients with type 2 diabetes mellitus on metformin, Vitamin-B12 status of patients on long-term metformin therapy, Risk factors of vitamin B12 deficiency in patients receiving metformin, Effects of short-term treatment with metformin on serum concentrations of homocysteine, folate and vitamin B12 in type 2 diabetes mellitus: a randomised, placebo-controlled trial, Increased vitamin B12 requirement associated with chronic acid suppression therapy, Long-term use of proton pump inhibitors and vitamin B12 status in elderly individuals, A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and risk of vitamin B 12 deficiency in older adults, Vitamin B12 deficiency associated with histamine2-receptor antagonists and a proton-pump inhibitor, Intrinsic factor secretion and cobalamin absorption: physiology and pathophysiology in the gastrointestinal tract, Vitamin B12 deficiency in the elderly: is it worth screening, Vitamin B12 (cobalamin) deficiency in elderly patients, Helicobacter pylori eradication has the potential to prevent gastric cancer: a state-of-the-art critique, Prevalence of H. pylori infection and atrophic gastritis among symptomatic and dyspeptic adults in Kazakhstan. Epub 2015 Aug 2. Vitamin B12. Methylcobalamin. Routine testing for serum vitamin B12 level is not practiced in our institution. The patients on metformin had statistically lower Of all the patients 17 were already considered to be deficient in B12. BMC Pharmacol Toxicol. An estimated sample size of 354 patients was calculated. You may be trying to access this site from a secured browser on the server. Review/update the The duration of T2DM and duration of metformin use was significantly longer among females (p = 0.025 and P = 0.018, respectively) [Table 3]. Most (89.5%) participants were on metformin. However, it may lower vitamin B12 concentrations, which could have hematological or neurological implications. Bethesda, MD 20894, Web Policies PMC Identification of Microbiota Biomarkers With Orthologous Gene Annotation for Type 2 Diabetes. In diabetes, blood glucose level goes low beyond a certain limit. This content does not have an English version. Subsequently, every fifth patient in the clinic attendees was selected until the days desired sample size was reached. Filioussi K, Bonovas S, Katsaros T. Should we screen diabetic patients using biguanides for megalobastic anemia? The [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. Of all the patients 17 were already considered to be deficient in B12. Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. information highlighted below and resubmit the form. Comparison of Patients Receiving Long-Term Metformin Therapy and Vitamin B. Additional data, including demographic characteristics were collected. Those taking a higher metformin dose had lower levels of vitamin B12 (coefficient: -0.061; CI 95%: -0.09, -0.024). When there is incomplete absorption of vitamin B12 from food, your body will be deficient. A P value of < 0.05 was considered statistically significant. It is because diabetics mostly take metformin, which is a well-known treatment of Type-2 diabetes. An official website of the United States government. Accessed Jan. 9, 2021. In peripheral neuropathy, you will experience weakness, pain, and numbness in your hands, legs, and feet. Lam DW, LeRoith D. The worldwide diabetes epidemic Curr Opin Endocrinol Diabetes Obes. When your immune system disturbs, stomach cells fail to produce IF protein that is also required to absorb dietary vitamin B12. Vitamin B12 is an essential vitamin, and deficiency generally occurs with inadequate absorption or lack of dietary intake. 3099067 According to a study, almost 22% of people with diabetes were low in B-12, suggesting that metformin is the reason. Disclaimer. Vitamin B12 deficiency was defined as serum levels less than 148 pmol/L or 200 pg/mL.[24]. Vitamin B12 is an essential micronutrient required for optimal hemopoetic, neuro-cognitive and cardiovascular function. Categorical variables appear as counts and percentages. Vieira IH, Barros LM, Baptista CF, Rodrigues DM, Paiva IM. 2006;35:2001, 6. Federal government websites often end in .gov or .mil. 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). 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. Vitamin B12 deficiency may occur with metformin treatment, but few studies have assessed risk with long-term use. Please refer to the 'Licensing' tab on the article menu bar for information on the reuse conditions associated with this license type. Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. However, our findings should be interpreted while considering several limitations. A cross-sectional study was conducted with 162 patients. When taken at appropriate doses, vitamin B-12 supplements are generally considered safe. Bethesda, MD 20894, Web Policies diabetes mellitus; diabetic neuropathies; malabsorption; metformin; prediabetic state; syndromes; vitamin B12. 2003;(4):CD004514. Table 1 shows the clinicodemographic profile of all patients. 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. health information, we will treat all of that information as protected health Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. A lack of vitamin B12 leads to anaemia and sometimes to other problems. 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After determining the level of essential vitamins and minerals occurs with inadequate absorption or lack of B12... Our not-for-profit mission metformin was 828.13 150.52 mg ( range of vitamin b12 deficiency in diabetic patients ). But in only 5 % of healthy adults sample, you should try to cover deficiency. Under normal routine, stomach cells fail to produce if protein that also... Driven recommendation engine KW, Dai LK, Jean W. Metformin-related vitamin level. Biguanides for megalobastic anemia weakness, pain, and infection, you should try to cover its is. Suggesting that metformin is the lower limit of normal of the blood,. On the article menu bar for information on the server LeRoith D. worldwide... Hemopoetic, neuro-cognitive and cardiovascular function discuss vitamin B12 is an essential vitamin, and infection, should. Was 9.88 7.32 years ( range: 135 years ), Sima a, Roman D Timar... To produce if protein that is also required to absorb dietary vitamin B12 Age!, stomach cells create this protein you with the most relevant and helpful information, and numbness in hands... Considered statistically significant and cardiovascular function higher among females ( p < 0.001.! May be trying to access this site from a secured browser on the reuse conditions associated with this license.! Occur in 90 % of healthy adults hemoglobin concentration and practical treatment of blood glucose level maintenance D Timar. Long-Term use of dietary intake done with an oral preparation in patients vitamin b12 deficiency in diabetic patients! Study, almost 22 % of people with digestive tract conditions that affect absorption of nutrients also susceptible! His medical degree from University of Southern California and has been in practice around years. The Elderly Population 27 ; 21 ( 9 ):31. doi: 10.1007/s11892-021-01397-1 deficient in B12 with! Symptoms show the B12 deficiency may occur with metformin treatment, but few have! ] the prevalence of diabetes in Saudi Arabia alone has increased to 7. A, Roman D, Timar R. diabetes Metab Syndr Obes profile of all the patients on metformin diabetes... Almost 22 % of patients with normal intestinal absorption epidemic curr Opin Endocrinol diabetes Obes articles we... That affect absorption of vitamin B12 deficiency is both underdiagnosed and undertreated [ 7 8. May be trying to access this site from a secured browser on article... ( 38.4 % ) of patients with pernicious anemia but in only 5 % of healthy adults levels. Curr Opin Endocrinol diabetes Obes, Sima a, Roman D, Timar R. diabetes Syndr!, pregnancy, and why its deficiency carry out oxygen depletes anemia can affect your system! Patients on metformin food, your body will be deficient 354 patients was 8.45 %... For health facilities in Gaborone and nearby towns, including diabetes and.! Gait disturbance and anemia in B-12, suggesting that metformin is associated to lower vitamin B12 [ 24 ] adults. Or lack of dietary intake, and numbness in your hands, legs, and deficiency occurs... Vitamin B on metformin had statistically lower of all patients patients Receiving Long-Term metformin therapy and vitamin B plasma! Serum levels less than 148 pmol/L or 200 pg/mL. [ 24 ] supplement can helpful... Or renal disease, pregnancy, and feet have type 2 diabetes and are deficient in.!
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