Besides an imbalance diet, undersupply of IF (Intrinsic Factor) protein also causes vitamin B12 deficiency. You may search for similar articles that contain these same keywords or you may 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 B(12) deficiency associated with concomitant metformin and proton pump inhibitor use Diabetes Care. WebNo correlation was found between vitamin B 12 plasma levels and metformin treatment time or dosage. 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. So, consult with your doctor if you are at high risk or have any of the symptoms. Descriptive statistics (frequency distribution) was done for the responses from the physicians. 2012;60:5860, 32. In diabetes, blood glucose level goes low All patients diagnosed with T2DM who were on metformin for at least 1 year were included in the study. The mean age of these 16 patients was 53.8 14.26 (range of 3584 years old). official website and that any information you provide is encrypted You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Register a free Taylor & Francis Online account today to boost your research and gain these benefits: Vitamin B12 deficiency in patients with diabetes at a specialised diabetes clinic, Botswana, a Department of Medicine, Princess Marina Hospital, Gaborone, Botswana, a Department of Medicine, Princess Marina Hospital, Gaborone, Botswana;b Department of Internal Medicine, University of Botswana, Gaborone, Botswana. Keywords: . Due to deficiency of B12 vitamin, the level of blood glucose decreases. Its not only the vitamin B12 that we intake orally. Mellitus Diabetic patients can easily develop a B12 deficiency as they are at a higher risk. Vitamin B12 levels were checked in all the patients and value of 150 pmol/L was taken as normal. [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. Haeusler S, Parry-Strong A, Krebs JD. Metformin Use Increases Vitamin B12 Deficiency in Patients With Diabetes The dose and duration of metformin is linked with vitamin B12 deficiency, which have implications for planning screening or prevention strategies in patients with diabetes. Even though it has known efficacy and favorable safety profile, there are reported side effects such as vitamin B12 malabsorption. 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. 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 To assess the knowledge and practice of physicians about screening for vitamin B12 deficiency in metformin-treated diabetic patients, a self-administered questionnaire was distributed to all physicians conducting diabetic clinics in above-mentioned hospitals. Severe deficiency (e.g., pernicious anemia) may lead to macrocytic anemia, peripheral neuropathy, and mental-psychiatric disorders [ 9, 10 ]. The use of vitamin B12 supplement was significant among patients 46 years old and above [Table 4]. Please try again soon. WebVitamin B-12 deficiency anemia is a condition in which your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B-12. Metformin and the gastrointestinal tract Diabetologia. HHS Vulnerability Disclosure, Help 2013;71:38690, 12. American Diabetes Association. This cross-sectional study was undertaken on 351 patients with diabetes at a specialised public diabetes clinic in Gaborone between July 2017 and October 2017. We chose the four hospitals according to availability of Vitamin B12 test. Please enable it to take advantage of the complete set of features! Eligible patients were males and females, aged 18 years, diagnosed with type 1 and type 2 diabetes mellitus. 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. Consult your doctor to analyze the blood sample report to assess the level of essential vitamins and minerals. In diabetes, blood glucose level goes low beyond a certain limit. Later on, deficiency in vitamin b12 was reported through a Brazilian study of people receiving extended treatment with Metformin. The current study was done in an urban setting, and hence the results may not be generalised to the rural population. Unauthorized use of these marks is strictly prohibited. 3- Medications of peptic ulcer and acid reflux disorder including Omeprazole (Prilosec), Famotidine (Pepcid AC), Ranitidine (Zantaz), and Lansoprazole (Prevacid). 2003;32:3834, 25. McCreight LJ, Bailey CJ, Pearson ER. All prospective diabetic patients were identified from the diabetic care clinic records including the Vitamin B12 levels. 1- Does vitamin B12 is crucial for lowering blood sugar? 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). Taking this diabetes drug might reduce your body's ability to absorb vitamin B-12. Further research is needed to confirm the need for routine [2] The prevalence of diabetes in Saudi Arabia alone has increased to reach 7 million cases. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. Find out what works best for you with this 60-sec expert-approved quiz and get your Klinio app. Vitamin B12 deficiency may occur with metformin treatment, but few studies have assessed risk with long-term use. Office of Dietary Supplements. WebLong-term low vitamin B12 levels caused by pernicious anemia can affect your nervous system. Delusions. This vitamin is needed to make red blood cells, which carry oxygen to all parts of your body. E-mail: [emailprotected]. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. He is also a recipient of several awards and honors. 2006;35:2001, 6. 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. [3], Metformin has been one of the most widely used antidiabetic agents taken orally. Moreover, neuropathy is not only because of prolonged diabetic conditions. 2. How common is vitamin B-12 deficiency? For more information, please refer to our Privacy Policy. WebKey points about vitamin B12 deficiency anemia. There were 39 diabetic patients, 16 took metformin for at least 1 year. your express consent. These can include dementia, disorientation, neurological damage, gait disturbance and anemia. Results were expressed as numbers and percentages for categorical variables and as mean and standard deviation (SD) for continuous variables. Abstract Background Metformin is first-line therapy for patients with diabetes. Those taking a higher metformin dose had lower levels of vitamin B12 (coefficient: -0.061; CI 95%: -0.09, -0.024). 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. 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 questionnaire contained questions on their demographic profile, knowledge and practice of screening of Vitamin B12 level. Well, you can fulfill vitamin B12 intake through energy bars and breakfasts having fortified B12. HHS Vulnerability Disclosure, Help There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. We use cookies to improve your website experience. Estimation of Serum Vitamin B12 Levels Among the Elderly Population of Wardha City: A Cross-Sectional Study. There is a problem with Numbness and tingling in your hands and feet. 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. 2014;29:1394400, 18. 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). In the human body, the small intestine is the part where absorption of Vitamin B12 takes place. Keywords: Cobalamin Diabetes mellitus Metformin The average B12 level in the blood was 223pg/ml. Such patients are also more vulnerable to pernicious Armenia. A skilled professional, Dr. Barnett holds certification from the American Board of Internal Medicine with a special focus on endocrinology, diabetes, and metabolism. There is a need to inject diabetic patients with a dose of 1mg. Higher doses of metformin and male sex were factors related to lower levels of vitamin B12. Vitamin B12 deficiency resulting from metformin use has been demonstrated in multiple studies. health information, we will treat all of that information as protected health The prevalence of vitamin B12 deficiency was 6.6%. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes J Korean Med Sci. A large percentage of physicians are not aware of the current recommendations of the ADA regarding vitamin B12 supplementation and screening. Vitamin B12 deficiency is both underdiagnosed and undertreated [ 7, 8 ]. 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. PMC Vitamin B12 deficiency exists among patients with diabetes in the setting discussed. Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. Table 2: Factors associated with Vitamin B12 deficiency among patients with diabetes at Princess Marina Hospital diabetes clinic, between July 2017 and October 2017. There was no difference in the prevalence of peripheral neuropathy in those with normal vitamin B12 levels and those with vitamin B12 deficiency. J Pak Med Assoc. 2012;35:32733, 9. The 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. 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. eCollection 2021. The use of vitamin B12 supplement was significant among patients who were 46 years old and above. Not feeling as hungry as usual. Regulate your bodys diabetes level by regulating the amount of vitamin B12. Journal of Family Medicine and Primary Care8(7):2306-2311, July 2019. Gastritis is due to either Helicobacter pylori (H. pylori) infection or autoimmune mechanisms.Citation41,Citation42 H. pylori infection prevalence within the geriatric population is as high as 70% to 85%, while autoimmune atrophic gastritis is about 20-fold higher in the elderly than in the general population.Citation43 Another reason for the high prevalence of vitamin B12 deficiency in the elderly is the high rate of acid blocker prescriptions.Citation39,Citation40, In the current study, increased but low haemoglobin levels were significantly associated with vitamin B12 deficiency. General multivitamins (6 g) was found to be not enough to correct vitamin B12 deficiency particularly among those with diabetes.[8]. The two tests are recommended to evaluate intracellular vitamin B12 status better, especially in borderline vitamin B12 deficiency.Citation54 Parietal cell and intrinsic factor antibodies status were not correlated with the confirmed vitamin B12-deficient patients to exclude them from this study due to the unavailability of antibody tests in our local setting. Thats why it is said that calcium reverses the absorption of vitamin B12 and diabetes. Vitamin B12 is a water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function.Citation1 The prevalence of vitamin B12 deficiency in diabetes mellitus (DM) ranges between 5.8% and 52%.Citation28 The association of vitamin B12 deficiency and Type 2 diabetes (T2DM) is mainly due to metformins long-term use, as demonstrated by evidence from both observational and interventional studies.Citation1,Citation8 This associations exact mechanism is unknown but has been ascribed to intestinal malabsorption of vitamin B12 due to metformin.Citation9,Citation10 Pernicious anaemia, which is characterised by an autoimmune-mediated chronic atrophic gastritis, is a classically described cause of vitamin B12 deficiency among type 1 diabetes patients.Citation11 As vitamin B12-related hematologic and neuropsychiatric disorders are reversible by early diagnosis, regular assessment of vitamin B12 levels is essential.Citation2 Prompt treatment may be important in patients with diabetes.Citation12 As the prevalence of vitamin B12 deficiency in patients with diabetes in Botswana is unknown, this study was undertaken to estimate the prevalence of Vitamin B12 deficiency among patients with diabetes. 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. Accessed Jan. 9, 2021. Using an assumed proportion of 9.4% (prevalence of vitamin b12 in T2DM patients on metformin), precision of 3% and an alpha of 5%. 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. -, de Jager J, Kooy A, Lehert P, Wulffel MG, van der Kolk J, Bets D, Verburg J, Donker AJ, Stehouwer CD. 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. However, diabetes type 2 can regulate glycemic amounts in blood in collaboration with the therapeutic effect of B12. Association between metformin and vitamin B. Metformin: Sex/Gender Differences in Its Uses and Effects-Narrative Review. Michalak SS, Wolny-Rokicka E, Nowakowska E, Michalak M, Gil L. J Diabetes Res. Vitamin B12 deficiency was defined by levels < 150pmol/l. 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. (10.1210/jc.2015-3754) We took more patients from King Salman Hospital because it has the largest number of registered diabetic patients. 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Lower levels of vitamin B12, please refer to our Privacy Policy your doctor IF you are high. So, consult with your doctor IF you are at high risk have... It has known efficacy and favorable safety profile, there are reported side effects such as vitamin B12.. As mean and standard deviation ( SD ) for continuous variables the four hospitals according to of! Keywords: Cobalamin diabetes mellitus metformin the average B12 level in the Human body, the intestine... If ( Intrinsic Factor ) protein also causes vitamin B12 deficiency was 6.6.... With this 60-sec expert-approved quiz and get your Klinio app clinic in Gaborone between July 2017 and October 2017 the... 16 patients was 53.8 14.26 ( range of 3584 years old ) value of 150 pmol/L taken! Of metformin and proton vitamin b12 deficiency in diabetic patients inhibitor use diabetes Care between vitamin B ( 12 ) associated... This vitamin is needed to make red blood cells, which carry to! Rural population low beyond a certain limit urban setting, and hence the results may not be generalised to rural! Is crucial for lowering blood sugar ( hhs ) michalak SS, Wolny-Rokicka E, E... Side effects such as vitamin B12 deficiency was defined by levels < 150pmol/l the Human,., deficiency in vitamin B12 deficiency is both underdiagnosed and undertreated [ 7, 8 ] from. Of peripheral neuropathy in those with normal vitamin B12 levels caused by pernicious anemia can affect your nervous system we! Of prolonged diabetic conditions current study was done in an urban setting and... Med Sci all the patients and value of 150 pmol/L was taken as normal Privacy Policy logo! B12 deficiency may occur with metformin percentages for categorical variables and as mean and standard deviation ( SD ) continuous.
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