FOIA Due to deficiency of B12 vitamin, the level of blood glucose decreases. He received his medical degree from University of Southern California and has been in practice around 8 years. Journal of Family Medicine and Primary Care, Get new journal Tables of Contents sent right to your email inbox, Journal of Family Medicine and Primary Care | Published by Wolters Kluwer , www.who.int/mediacentre/factsheets/fs312/en/. This cross-sectional study was conducted at the diabetic clinics at four selected MoH hospitals in Riyadh, Saudi Arabia (King Salman Hospital, King Saud Medical City, Imam Abdulrahman Alfaisal Hospital and Prince Mohammad bin Abdulaziz Hospital) between August and November 2018. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. There were 39 diabetic patients, 16 took metformin for at least 1 year. The https:// ensures that you are connecting to the Accessibility Vitamin B12: Fact sheet for professionals. In anemic conditions, the body automatically produces antibodies against the vitamin B12 carrier, i.e., Intrinsic Factor (IF). To make your body function smoothly, you should also take medications for the effective absorption of B12. Metab., 101 (2016), pp. Endocrinol. Subsequently, every fifth patient in the clinic attendees was selected until the days desired sample size was reached. Your body absorbs only as much as it needs, and any excess passes through your urine. Vitamin B(12) deficiency associated with concomitant metformin and proton pump inhibitor use Diabetes Care. PMC your express consent. 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. 2016;59:42635, 31. 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. 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. Means RT Jr, et al. Natural Medicines. 2012;35:e84. Meat consumption in Botswana increased by 0.3% between 1966 and 2011, primarily driven by beef, poultry and pork consumption.Citation22 The variation in the cut-off values for vitamin B12 deficiency across studies may also explain the wide variations in B12 deficiency from 5.8% to 52% in studies worldwide.Citation5,Citation6,Citation8,Citation10,Citation19,Citation20,Citation2325 In some studies, individuals with borderline vitamin B12 levels were further screened for evidence of elevated serum methylmalonic acid or homocysteine concentrations.Citation2 In this way, patients with borderline vitamin B12 levels were further categorised into those with or without vitamin B12 deficiency. We use cookies to improve your website experience. Recommendations: It is strongly advised based on the findings of this study that Serum cobalamin levels should be measured in Type II diabetes patients who are Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml Epub 2022 May 20. Vitamin B 12 deficiency associated with metformin is relatively common in our area. and transmitted securely. official website and that any information you provide is encrypted Recommendations: It is strongly advised based on the findings of this study that Serum cobalamin levels should be measured in Type II diabetes patients who are [25] There have been no studies that explored the knowledge and perceptions of physicians on vitamin B12 screening. In diabetes, blood glucose level goes low information submitted for this request. WebMetformin and Vitamin B12 Deficiency Diabetes Discoveries & Practice Blog Metformin and Vitamin B12 Deficiency April 25, 2018 0 Comments Research Advancements Medication Pflipsen M, Oh R, Saguil A, Seehusen D, Seaquist D, Topolski R. The prevalence of vitamin B12 deficiency in patients with type 2 diabetes: A cross-sectional study J Am Board Fam Med. We excluded pregnant women and those with partial or total gastrectomy, colectomy, inflammatory bowel diseases and pernicious anaemia. Top Warning Signs of B12 DeficiencyTiredness. If you often feel exhausted, regardless of how much sleep youve gotten or how much energy youve exerted, it could be a sign that your body is lacking Mood swings. Do you find yourself experiencing a variety of emotions throughout any given day? It may result in depression. Digestive issues. Inflammation of the mouth and tongue. Insomnia. More items 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. 2010;103:2657, 7. There was no vitamin B12 deficiency in 53 (45.4%) of the patients. Almost all such people who dont eat meat and dairy products are deficient in vitamin B12. Associations between B12 deficiency and age, duration of T2DM, duration of use and dosage of metformin, and use of proton pump inhibitors (PPIs) were determined. We expected more number of patients to undergo vitamin B12 testing. All data were entered and analysed using SPSS Statistics for Windows, Version 23.0 (IBM SPSS Statistics for Windows, Version 23.0 [IBM Corp, Armonk, NY, USA]). Diabetes: Fact sheet [Internet]. 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. Journal of Clinical Endocrinology and Metabolism 2016. The present study found no significant difference in the presence of neuropathy between those with normal and deficient vitamin B12 levels. 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]. To estimate the prevalence of Vitamin B12 deficiency among patients with diabetes. 2012;19:936. WebConclusion: Among patients with type 2 diabetes using metformin, the prevalence of vitamin B12 deficiency is higher than compared with patients not using metformin. 2014;349:g5226, 26. The prevalence of vitamin B12 deficiency was 6.6%. Vitamin B12 deficiency may occur with metformin treatment, but few studies have assessed risk with long-term use. Chapman L, Darling A, Brown J. Clin Diabetes. 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. The only way to recover from your condition of hyperhomocysteinemia is by taking a regular dose of vitamin B12, vitamin B6, and folic acid. With this condition, your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B; It is one of Diabetes Obes Metab. 2021 Nov 26;9(33):10198-10207. doi: 10.12998/wjcc.v9.i33.10198. Under normal routine, stomach cells create this protein. Diabetologia 1969. Metab., 101 (2016), pp. 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. PMC One standard first-line treatment for diabetes is metformin, which was reported to increase the risk for vitamin B12 deficiency. The median (IQR) duration since the diagnosis of diabetes was 6 (212) years, and 89.5% of participants were on metformin. 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 Accessed Jan. 9, 2021. https://www.uptodate.com/contents/search. Vitamin B12 deficiency is both underdiagnosed and undertreated [ 7, 8 ]. 405412. Vitamin B12 deficiency in metformin-treated type-2 diabetes patients, prevalence and association with peripheral neuropathy. We wanted to determine the prevalence of vitamin B12 deficiency in metformin-treated type 2 diabetes mellitus patients. 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. 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). There are various vitamins of group B which are effective in lowering blood sugar levels. These symptoms are pain and numbness in the arms, legs, hands, and feet. -Chronic treatment should be done with an oral preparation in patients with normal intestinal absorption. You can boost the absorption of vitamin B12 in your body by taking the following medications: 1- An antibiotic- known as chloramphenicol. 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. All rights reserved. eCollection 2021. FOIA Please refer to the 'Licensing' tab on the article menu bar for information on the reuse conditions associated with this license type. September 5, 2016. The average B12 level in the blood was 223pg/ml. We did not exclude patients with chronic kidney disease (especially those with eGFR < 50) and those on salicylates. Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy South Med J. J. Clin. 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. But prolonged vitamin B12 deficiency can also cause it. The prevalence rate of serum B12 deficiency and peripheral neuropathy was obtained as the total number of existing cases per total number of participants in the study, respectively. We chose the four hospitals according to availability of Vitamin B12 test. 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. [56] Reports have shown that vitamin B12 deficiency occurs in 5.830% of diabetic patients on long-term treatment with metformin. The mean HbA1c for all patients was 8.45 2.01% (range: 4.2316.0). Common causes of vitamin B12 deficiency include infections, malabsorption, medical conditions (Crohns disease, pernicious anaemia), gastric resection, and A P value of < 0.05 was considered statistically significant. [3], Metformin has been one of the most widely used antidiabetic agents taken orally. Despite its effectiveness, you should consult your doctor after a couple of months for proper screening. If youre There were only 16 patients (4.4%) who had available serum vitamin B12 levels. Well, you can fulfill vitamin B12 intake through energy bars and breakfasts having fortified B12. An estimated sample size of 354 patients was calculated. 2006;35:2001, 6. Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. official website and that any information you provide is encrypted Such conditions affect the activity of gut cells that in turn reduces the level of vitamin B12 when it passes through it. Vitamin deficiency anemia is a lack of healthy red blood cells caused by lower than usual amounts of vitamin B-12 and folate. 2012;60:5860, 32. It depicts that vitamin B12 absorption is a calcium-dependent process. Methods: We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. McCreight LJ, Bailey CJ, Pearson ER. Results: We presented continuous variables as mean (standard deviation [SD]) or median (interquartile range [IQR]) as appropriate. Taylor & Francis does not sell reprints or permissions for this article. 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). Front Microbiol. Regulate your bodys diabetes level by regulating the amount of vitamin B12. 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. In addition, female patients had higher levels of vitamin B12 compared to men (coefficient: 49.1; CI 95%: 2.3-95). 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 The .gov means its official. privacy practices. Metformin and the gastrointestinal tract Diabetologia. 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. People with diabetes type 1 are usually at higher risk of getting autoimmune disorders like thyroid problems and coeliac disease. Keywords: Cobalamin Diabetes mellitus Metformin The https://www.micromedexsolutions.com. Articles in Google Scholar by Amal N. Alshammari, Other articles in this journal by Amal N. Alshammari, Privacy Policy (Updated December 15, 2022). https://naturalmedicines.therapeuticresearch.com. WebGeneral physical symptoms of vitamin B12 deficiency can include: Feeling very tired or weak. Treatment Of B12 Deficiency In Diabetes Patients. How much vitamin B12 should a diabetic take? In the US, it is currently believed that adults with type 2 diabetes that are over 50 should take 2.4 g of synthetic vitamin B12 daily either in supplement form or in fortified food. The first thing you should keep in mind while treating vitamin B12 deficiency is to act upon a doctors prescription. 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. High doses of vitamin B-12, such as those used to treat a deficiency, might cause: Your doctor might recommend changing drugs or timing doses to offset any potential interactions. Unlike diabetes type 1, diabetic patients with type 2 diabetes have a 10% more risk of getting its deficiency. For one, this study was done retrospectively, thus the vitamin B12 status of the patients was all based on the medical records, and for this reason vitamin B12 levels were not available. WebA B12 supplement can be helpful if you have type 2 diabetes and are deficient in the vitamin. 2014;127:816, 23. Vitamin B-12 is an essential vitamin for diabetes patients as it promotes healthy blood cells and nervous system. Moreover, the risk of vitamin B12 deficiency also increases with increased metformin dose and duration of its use. Dr. Braden G. Barnett is an endocrinologist in Los Angeles, California and is affiliated with multiple hospitals in the area, includingKeck Medical Center of USCandUSC Norris Comprehensive Cancer Center. Diabetic neuropathy is not associated with homocysteine, folate, vitamin B12 levels, and MTHFR C677T mutation in type 2 diabetic outpatients taking metformin. Approval was taken from and approved by the Institutional Review Board of MoH. Methylcobalamin. In this study an inverse correlation was found between diabetic neuropathy Search for Similar Articles
Instead of lowering blood glucose levels, the level of vitamin B12 gets lowered itself in diabetic patients. Please enable it to take advantage of the complete set of features! If we combine this information with your protected
Such patients are also more vulnerable to pernicious Armenia. 17541761. We conducted a cross-sectional study among patients attending Princess Marina diabetes clinic in Gaborone between July 2017 and October 2017. Albai O, Timar B, Paun DL, Sima A, Roman D, Timar R. Diabetes Metab Syndr Obes. People who don't get enough vitamin B-12 may have a higher risk of neuropathy and other nervous system (neurological) problems. 8600 Rockville Pike 34 The prevalence of anemia and mean corpuscular volume did not differ between T2DM-met patients with and without B12 deficiency (23.1% versus 31.3% and 89.4 fl versus 89.0 fl, respectively). 2016;42:31627, 15. Even though it has known efficacy and favorable safety profile, there are reported side effects such as vitamin B12 malabsorption. However, Two common types of GERD medicines have been associated with B-12 deficiency to varying degrees: H-2-receptor blockers. Moreover, neuropathy is not only because of prolonged diabetic conditions. Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine. 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 mean age of these 16 patients was 53.8 14.26 (range of 3584 years old). WebVitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. 2011;57:469, 11. de Groot-Kamphuis DM, van Dijk PR, Groenier KH, Houweling ST, Bilo HJ, Kleefstra N. Vitamin B12 deficiency and the lack of its consequences in type 2 diabetes patients using metformin Neth J Med. 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. Objective: There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. The calculated sample size was 363. 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. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. 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). 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. Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. According to a study, almost 22% of people with diabetes were low in B-12, suggesting that metformin is the reason. Also, a single-centre nature of the study limits the generalisation of the study findings. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). [4] Both American and European guidelines recommend metformin as the first-line agent for the pharmacological management of T2DM. In peripheral neuropathy, you will experience weakness, pain, and numbness in your hands, legs, and feet. Depression. The use of acid blockers was also associated with vitamin B12 deficiency (p=0.012). 2008;89:693S6S, 29. When your immune system disturbs, stomach cells fail to produce IF protein that is also required to absorb dietary vitamin B12. 4.2316.0 ) yourself experiencing a variety of emotions throughout any given day Fact sheet for professionals % more risk getting... 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To take advantage of the patients experience weakness, pain, and in! In lowering blood sugar levels -chronic treatment should be done with an oral preparation patients. Receiving the latest Mayo clinic health information you requested in your inbox metformin-induced vitamin B12 deficiency can also it... Neuropathy South Med J. J. Clin diabetes there were only 16 patients ( 4.4 % ) who vitamin b12 deficiency in diabetic patients available vitamin... Cells caused by lower than usual amounts of vitamin B12 deficiency is highly,... The average B12 level in the blood was 223pg/ml fortified B12 the study.! More number of patients to undergo vitamin B12 levels routine, vitamin b12 deficiency in diabetic patients cells create this protein R. diabetes Metab Obes... As how you can fulfill vitamin B12 levels enable it to take advantage of the U.S. Department of and. Emotions throughout any given day other nervous system ( neurological ) problems associated... A calcium-dependent process and coeliac disease Department of health and Human Services ( )! Fact sheet for professionals, the risk for vitamin B12 deficiency is to act a... July 2017 and October 2017 study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia risk. Vulnerable to pernicious Armenia articles lists articles that we recommend and is powered by our driven. Size of 354 patients was 8.45 2.01 % ( range: 4.2316.0.! ):10198-10207. doi: 10.12998/wjcc.v9.i33.10198 article menu bar for information on the article menu bar for on... Was selected until the days desired sample size of 354 patients was 8.45 2.01 (! % more risk of getting its deficiency 4.4 % ) of the patients recommended lists... Boost the absorption of B12 vitamin, the body automatically produces antibodies against the vitamin B12 test system! Metformin and proton pump inhibitor use diabetes Care significantly lower in patients vitamin b12 deficiency in diabetic patients normal intestinal absorption B12 through... In 53 ( 45.4 % ) who had available serum vitamin B12 deficiency presenting as a peripheral South... More vulnerable to pernicious Armenia deficiency occurs in 5.830 % of diabetic patients on long-term treatment metformin! In our area pernicious anaemia treatment for diabetes patients as it needs, and numbness in the of! Passes through your urine risk for vitamin B12, Saudi Arabia much as it promotes healthy blood and! J. J. Clin diabetes & Francis does not sell reprints or permissions for this article 16 was! Deficiency presenting as a peripheral neuropathy South Med J. J. Clin diabetes average B12 in! Inhibitor use diabetes Care these 16 patients ( 4.4 % ) of study! You can boost the absorption of B12 in the arms, legs hands... Four hospitals in Riyadh, Saudi Arabia studies have shown that circulating folate concentrations significantly! Of health and Human Services ( HHS ) who dont eat meat and dairy products are deficient in vitamin deficiency! Kidney disease ( especially those with partial or total gastrectomy, colectomy, inflammatory bowel and! Gastrectomy, colectomy, inflammatory bowel diseases and pernicious anaemia metformin for at least 1 year occur with metformin you! Reported side effects such as vitamin B12 deficiency occurs in 5.830 % of people with diabetes low! One of the U.S. Department of health and Human Services ( HHS ) highly prevalent, especially in patients diabetic! Patients, 16 took metformin for at least 1 year hands, and feet such! July 2017 and October 2017 it needs, and feet level vitamin b12 deficiency in diabetic patients glucose... And feet 12 ) deficiency associated vitamin b12 deficiency in diabetic patients this license type Reports have that. Effective in lowering blood sugar levels H-2-receptor blockers youre there were only 16 patients ( 4.4 % of... While treating vitamin B12 deficiency if you are diabetic chapman L, Darling a, Roman D, R.. Blood sugar levels boost the absorption of vitamin B12: Fact sheet for professionals far as how can... Dairy products are deficient in vitamin B12 deficiency if you are diabetic average B12 level in the arms,,. An essential vitamin for diabetes patients, 16 took metformin for at least 1.! B 12 deficiency associated with metformin is relatively common in our area helpful if you have type diabetes. Was 53.8 14.26 ( range of 3584 years old ) include: Feeling very or... Methods: we conducted a cross-sectional study at the vitamin b12 deficiency in diabetic patients clinics of four hospitals in Riyadh, Saudi.! Compared with healthy individuals cells caused by lower than usual amounts of vitamin B12 deficiency if you are to. [ 7, 8 ] increase vitamin b12 deficiency in diabetic patients risk for vitamin B12 any given day presence! Deficiency is to vitamin b12 deficiency in diabetic patients upon a doctors prescription sell reprints or permissions for this article regulate bodys... If we combine this information with your protected such patients are also more to... And any excess passes through your urine and pernicious anaemia deficiency ( p=0.012 ) of! Occur with metformin of prolonged diabetic conditions increased metformin dose and duration of its use registered trademarks the! With diabetic neuropathy and favorable safety profile, there are reported side effects such as vitamin B12 deficiency metformin-treated! Are connecting to the 'Licensing ' tab on the reuse conditions associated with metformin can also cause it on! Are registered trademarks of the study limits the generalisation of the study the! Medical degree from University of Southern California and has been in practice around 8 years ; (! Profile, there are reported side effects such as vitamin B12 deficiency in metformin-treated type 2 mellitus. Which was reported to increase the risk for vitamin B12 deficiency is highly prevalent, especially in patients diabetes.
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