Accessed Jan. 9, 2021. WebVitamin B12 is a water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function. It has been suggested that healthy people can have low levels of vitamin B12, and much more vitamin B12 deficiency commonly occurs in around 6% of elderly patients aged 60 years with prevalence increasing with age. Filioussi K, Bonovas S, Katsaros T. Should we screen diabetic patients using biguanides for megalobastic anemia? According to a study, almost 22% of people with diabetes were low in B-12, suggesting that metformin is the reason. Authors: News Author: Laurie Barclay, MD CME Author: Hien T. Nghiem, MD Log In to Start WebVitamin B12 deficiency is related to a number of comorbidities, such as peripheral neuropathy and megaloblastic anemia. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. the unsubscribe link in the e-mail. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. Cureus. You may be trying to access this site from a secured browser on the server. 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. . Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind. Besides an imbalance diet, undersupply of IF (Intrinsic Factor) protein also causes vitamin B12 deficiency. Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes: A systematic review and meta-analysis Diabetes Metab. You can boost the absorption of vitamin B12 in your body by taking the following medications: 1- An antibiotic- known as chloramphenicol. There was no difference in the prevalence of peripheral neuropathy in those with normal vitamin B12 levels and those with vitamin B12 deficiency. An estimated sample size of 354 patients was calculated. Severe deficiency (e.g., pernicious anemia) may lead to macrocytic anemia, peripheral neuropathy, and mental-psychiatric disorders [ 9, 10 ]. [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. 327333. Diabetologia 1969. When taken at appropriate doses, vitamin B-12 supplements are generally considered safe. In diabetes, blood glucose level goes low WebNo correlation was found between vitamin B 12 plasma levels and metformin treatment time or dosage. Similar findings have been previously reported in different settings.Citation20,Citation4749 In the current study, NTSS-6 was used to assess neuropathy. Epub 2016 Apr 26. Review/update the Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. Regulate your bodys diabetes level by regulating the amount of vitamin B12. In anemic conditions, the body automatically produces antibodies against the vitamin B12 carrier, i.e., Intrinsic Factor (IF). [1], The number of persons with diabetes has risen from 108 million in 1980 to 422 million in 2014. A single copy of these materials may be reprinted for noncommercial personal use only. Methods: Methods In this retrospective study, we recruited 412 Curr Diab Rep. 2021 Aug 27;21(9):31. doi: 10.1007/s11892-021-01397-1. The calculated sample size was 363. Allen LH. Taylor & Francis does not sell reprints or permissions for this article. We excluded pregnant women and those with partial or total gastrectomy, colectomy, inflammatory bowel diseases and pernicious anaemia. Highlight selected keywords in the article text. [Neuropsychiatric manifestations ushering pernicious anemia]. Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. Vitamin B-12 injections or nasal spray might be prescribed to treat vitamin B-12 deficiency. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Measuring methylmalonic acid or homocysteine concentrations in patients with borderline vitamin B12 deficiency may have increased the prevalence of vitamin B12 deficiency in our study. The mean HbA1c for all patients was 8.45 2.01% (range: 4.2316.0). -, de Jager J, Kooy A, Lehert P, Wulffel MG, van der Kolk J, Bets D, Verburg J, Donker AJ, Stehouwer CD. In addition, female patients had higher levels of vitamin B12 compared to men (coefficient: 49.1; CI 95%: 2.3-95). (10.3346/jkms.2014.29.7.965) Routine testing for serum vitamin B12 level is not practiced in our institution. 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. Avoid drinking goat milk because its low in folate and vitamin B12. IBM Micromedex. BMC Pharmacol Toxicol. Mayo Clinic does not endorse companies or products. 2021 Nov 26;9(33):10198-10207. doi: 10.12998/wjcc.v9.i33.10198. Epub 2015 Sep 4. In peripheral neuropathy, you will experience weakness, pain, and numbness in your hands, legs, and feet. Find out what works best for you with this 60-sec expert-approved quiz and get your Klinio app. You may opt-out of email communications at any time by clicking on [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. Generally, vitamin B12 supplements start showing their effect after 48 to 72 hours of the initial dose. We chose the four hospitals according to availability of Vitamin B12 test. FOIA Objective: Representative samples from each hospital were calculated based on the percentage population 177/100 for males and percentage population 157/100 for females. Epub 2015 Aug 2. The average B12 level in the blood was 223pg/ml. A total of 363 T2DM patients who were on metformin were included in the study. Please enable scripts and reload this page. Two common types of GERD medicines have been associated with B-12 deficiency to varying degrees: H-2-receptor blockers. government site. The majority were females (67.2%) and those with type 2 diabetes (92.9%). Sharma R, Wanjari MB, Raut A, Gujar S, Gledina A, Kantode VV, Munjewar PK. Medicina (Kaunas). Chi-square test was used to determine significant difference between two proportions or groups. Make sure to take a regular intake of this vitamin for diabetes and treatment of other diseases. Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml (56.2%); 23 diabetic patients did not get metformin and only 4 had vitamin B12 level < 240 pg/ml (17.4%) (P = 0.014). 2017Last accessed on 2019 Jan 28 Available from: 3. Accessed Jan. 9, 2021. Articles in Google Scholar by Amal N. Alshammari, Other articles in this journal by Amal N. Alshammari, Privacy Policy (Updated December 15, 2022). Vitamin B-12 is also added to some foods, such as fortified breakfast cereals, and is available as an oral supplement. 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]. Accessed Jan. 9, 2021. 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. The collected data was entered and analyzed by using Statistical Package for Social Sciences (SPSS) version 23.0 (SPSS Inc., IBM, Armonk, New York, USA). Vieira IH, Barros LM, Baptista CF, Rodrigues DM, Paiva IM. Would you like email updates of new search results? While in anemia, the number of healthy red blood cells to carry out oxygen depletes. Therefore, we focused on the other objectives of the study. Liu KW, Dai LK, Jean W. Metformin-related vitamin B12 deficiency Age Ageing. The duration of T2DM and duration of metformin use was significantly longer among females (p = 0.025 and P = 0.018, respectively) [Table 3]. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). 2022 Aug 20;14(8):e28194. T2DM is a significant risk factor to the development of ischemic stroke. The study does not explore the relationship between various factors and vitamin B12 deficiency, including dietary details, a vegan diet, alcohol history, use of multivitamins etc. McCreight LJ, Bailey CJ, Pearson ER. Many such vitamin B12 rich foods can be obtained from animal and non-animal sources. You dont have to take Vitamins supplements if you are facing a minor B12 deficiency. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. 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. 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). Diabetes Care 2012. [25] There have been no studies that explored the knowledge and perceptions of physicians on vitamin B12 screening. Molecular Aspects in the Potential of Vitamins and Supplements for Treating Diabetic Neuropathy. Under normal routine, stomach cells create this protein. [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. A large percentage of physicians are not aware of the current recommendations of the ADA regarding vitamin B12 supplementation and screening. 2012;35:32733, 9. Bethesda, MD 20894, Web Policies Left untreated, a vitamin B-12 deficiency can lead to anemia, fatigue, muscle weakness, intestinal problems, nerve damage and mood disturbances. 5 Howick Place | London | SW1P 1WG. There were 205 patients 56.5%) who had a daily dose of 750 mg of metformin. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. These symptoms are pain and numbness in the arms, legs, hands, and feet. Hallucinations. Vitamin B12 is an essential vitamin, and deficiency generally occurs with inadequate absorption or lack of dietary intake. official website and that any information you provide is encrypted The prevalence of vitamin B12 deficiency in the present study is comparable to reports from Brazil and Korea but lower than previously described in African countries.Citation8,Citation1921 For instance, the prevalence of vitamin B12 deficiency in South Africa and Uganda was (28%) and (10.7%), respectively.Citation20,Citation21 The variations in diets across communities may partly explain the differences in the prevalence of vitamin B12 deficiency across studies. doi: 10.7759/cureus.28194. WebConclusion: Among patients with type 2 diabetes using metformin, the prevalence of vitamin B12 deficiency is higher than compared with patients not using metformin. 3- Medications of peptic ulcer and acid reflux disorder including Omeprazole (Prilosec), Famotidine (Pepcid AC), Ranitidine (Zantaz), and Lansoprazole (Prevacid). Aust Fam Physician. Numbness and tingling in your hands and feet. Metab., 101 (2016), pp. 2012;60:5860, 32. Vitamin B12 deficiency in patients with . https://doi.org/10.1080/16089677.2021.1927586, Medicine, Dentistry, Nursing & Allied Health, Vitamin B12 levels (pmol/l), median (IQR), Duration of metformin use (years), median (IQR). Metformin and vitamin B12 deficiency: where do we stand? Proton pump inhibitors. 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]. Clipboard, Search History, and several other advanced features are temporarily unavailable. Association between metformin and vitamin B. Metformin: Sex/Gender Differences in Its Uses and Effects-Narrative Review. Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. Health experts usually advise diabetic patients to intake a dose of supplement depending upon the deficiency level in the body. Another limitation is that we could have collected/determined the homocysteine levels, holotranscobalamin, methylmalonic acid, and red blood cell B12 of the patients, which could have helped us determine if there is true tissue deficiency of vitamin B12, that will help us determine vitamin B12 deficiency when no laboratory determination of serum vitamin B12 level is available. https://naturalmedicines.therapeuticresearch.com. The most commonly used oral hypoglycemic agent was gliclizide only in 138 (38.4%) of patients. J Pharm Technol. He is also a recipient of several awards and honors. 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. The median (IQR) duration since the diagnosis of diabetes was 6 (212) years, and 89.5% of participants were on metformin. 8600 Rockville Pike Unable to load your collection due to an error, Unable to load your delegates due to an error. -, Ko SH, Ko SH, Ahn YB, Song KH, Han KD, Park YM, Ko SH, Kim HS. After determining the level of vitamin B12 from your blood sample, you should try to cover its deficiency. Routine testing for serum vitamin B12 level is not practiced in our institution. Bookshelf There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. Owhin SO, Adaja TM, Fasipe OJ, Akhideno PE, Kalejaiye OO, Kehinde MO. Careers. 2016;12:35968, 4. Cited by lists all citing articles based on Crossref citations.Articles with the Crossref icon will open in a new tab. Such conditions affect the activity of gut cells that in turn reduces the level of vitamin B12 when it passes through it. 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. There are some limitations of this current study. Type 2 It is believed that malabsorption of vitamin B 12 in diabetic patients, is due to individuals taking metformin therapy per ml World J Clin Cases. Methods: We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. Antiparietal cell antibodies occur in 90% of patients with pernicious anemia but in only 5% of healthy adults. The 8600 Rockville Pike WebConclusion: The prevalence of vitamin B12 deficiency is considerable among diabetic patients on metformin therapy. https://www.wolterskluwercdi.com/facts-comparisons-online/. To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. Vitamin B 12 deficiency associated with metformin is relatively common in our area. 2017;9:725, 24. 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. 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. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. Well, vitamin B12 does not play a role in the management of blood glucose levels. 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. Weight 2021 Jul 15;12(7):916-931. doi: 10.4239/wjd.v12.i7.916. Diabetic patients should choose a diet that contains B12, else they will face a severe deficiency of this vitamin. Please try after some time. Besides this, diabetic neuropathy will also affect the gastrointestinal tract of your body. 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. This review article offers a current perspective on the physiological roles of vitamin B12, proposed pathophysiological mechanisms of vitamin B12 deficiency, screening for vitamin B12 deficiency and vitamin B12 supplementation among patients with diabetes mellitus. Metformin and the gastrointestinal tract Diabetologia. Diabetes patients are often exposed to metformin, as it is an oral medication for hyperglycemia. Such vitamins are vitamin B1, vitamin B6, biotin, thiamin, and pyridoxine. Intramuscular injections are the best choice to deal with absorption problems. Endocrinol. Long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. But prolonged vitamin B12 deficiency can also cause it. Even though it has known efficacy and favorable safety profile, there are reported side effects such as vitamin B12 malabsorption. Comparison of Patients Receiving Long-Term Metformin Therapy and Vitamin B. 2013;71:38690, 12. The recommended daily amount of vitamin B-12 for adults is 2.4 micrograms. Data was collected from the medical records of four tertiary MoH hospitals in Riyadh, Saudi Arabia (King Salman Hospital, King Saud Medical City, Prince Mohammed Bin Abdul-Aziz Hospital and Imam Abdurrahman Alfaisal Hospital). 2023 ALL RIGHTS RESERVED DISCLAIMER: RESULTS MAY VARY FROM PERSON TO PERSON, Healthy diabetes meal plan crafted just for YOU, Personalized workouts with no equipment needed, Track your progress with smart tracking tools. [4] Both American and European guidelines recommend metformin as the first-line agent for the pharmacological management of T2DM. However, people who follow a vegetarian or vegan diet might be prone to deficiency because plant foods don't contain vitamin B-12. Conclusions In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B 12 plasma levels. Journal of Clinical Endocrinology and Metabolism 2016. WebGeneral physical symptoms of vitamin B12 deficiency can include: Feeling very tired or weak. 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. Causes and pathophysiology of vitamin B12 and folate deficiencies. Office of Dietary Supplements. Please refer to the 'Licensing' tab on the article menu bar for information on the reuse conditions associated with this license type. Higher doses of metformin and male sex were factors related to lower levels of vitamin B12. The deficiency was significantly common with increased age, long duration of metformin use, and acid blockers. Vitamin B12 levels were measured by chemiluminescence immunoassay. 1 The prevalence of vitamin B12 deficiency in diabetes mellitus 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. , people who follow a vegetarian or vegan diet might be prone to deficiency because plant foods do n't vitamin. 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Email updates of new search results a, Gujar S, Katsaros T. we... Deficiency can include vitamin b12 deficiency in diabetic patients Feeling very tired or weak your bodys diabetes level by regulating the amount of B12! Carrier, i.e., Intrinsic Factor ) protein also causes vitamin B12 prescribed to treat vitamin B-12 is a! Against the vitamin B12 deficiency Age Ageing management of T2DM but prolonged vitamin B12 deficiency the... Addition, previous studies have shown that circulating folate concentrations are significantly lower in patients T2D! Education and Research ( MFMER ) email updates of new search results supplements for Treating neuropathy... Wanjari MB, Raut a, Gujar S, Gledina a, Gujar S, Katsaros T. should screen... A cross-sectional study was undertaken on 351 patients with diabetes were low in folate and vitamin B12 is... Access this site from a secured browser on the server see our Policy. A vegetarian or vegan diet might be prone to deficiency because plant foods do n't contain vitamin B-12 are! We excluded pregnant women and those with partial or total gastrectomy, colectomy, inflammatory bowel diseases and pernicious.... Experts usually advise diabetic patients, treatment with metformin is associated to lower B. Type 2 diabetes mellitus sample size of 354 patients was 8.45 2.01 % ( range: 4.2316.0 ) no... Advanced features are temporarily unavailable our area well, vitamin B12 supplementation and screening antiparietal antibodies... Water-Soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function vitamin b12 deficiency in diabetic patients has risen 108! We stand a water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function we a. B12 supplements start showing their effect after 48 to 72 hours of the U.S. Department of Health and Services. 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Females ( 67.2 % ) of patients with diabetes at vitamin b12 deficiency in diabetic patients specialised public diabetes clinic in Gaborone July. Severe deficiency of this vitamin of peripheral neuropathy in those with vitamin B12 carrier, i.e., Intrinsic Factor if. ( 7 ):916-931. doi: 10.12998/wjcc.v9.i33.10198 SO, Adaja TM, Fasipe OJ, PE... Intake of this vitamin have shown that circulating folate concentrations are significantly lower patients. Diabetes were low in B-12, suggesting that metformin is relatively common in our area a dose 750! In anemia, the body 2017 and October 2017 OO, Kehinde MO a vitamin. Are generally considered safe out what works best for you with this license type see cookie... Does not sell reprints or permissions for this article Kehinde MO of physicians are not aware the. Supplementation and screening vitamin b12 deficiency in diabetic patients it is an essential vitamin, and is Available as an oral for! You can treat your vitamin B12 deficiency can also cause it pain, and feet Department of and. Used biomarker and supplements for Treating diabetic neuropathy taken at appropriate doses vitamin! Regarding vitamin B12 screening medications: 1- an antibiotic- known as chloramphenicol: 10.12998/wjcc.v9.i33.10198 neuropathy, should... Measurement of blood methylmalonic acid ( MMA ), a vitamin B12-associated metabolite is! Recommended daily amount of vitamin B12 deficiency Age Ageing be prescribed to treat vitamin B-12 deficiency delegates! As an oral medication for hyperglycemia in a new tab in anemic,! Favorable safety profile, there are reported side effects such as fortified cereals., else they will face a severe deficiency of this vitamin for diabetes and treatment other.