Assessment of Serum Vitamin B12 Amongdiabetic Patients Under Treatment With Metformin in a Tertiary Care Centre

Abstract

Background: Type 2 diabetes mellitus (DM) is a widespread metabolic health disease. The oral hypoglycemic drug metformin is prescribed to type 2 diabetic patients worldwide as a first line treatment along with lifestyle changes.The risk of vitamin B12 deficiency and its medical repercussions in diabetic patients increases with ongoing metformin medication.Aim:To assess the vitaminB12 levels in type 2 diabetes mellitus patients on metformin and to determine the association with duration and dose metformin. Materials and Method: The present study was a Cross Sectional Observational Study conducted for a period of 6 months in department of General Medicine,Sree Mookambika Institute of Medical Sciences.There were 120 consecutive cases of Type 2 DM receiving metformin medication in the study group. Each patient's medical history was reviewed to identify the length of their metformin therapy and past dosages, and these dosages were vocally confirmed by the patients.Results were analyzed using SPSS 20.0 version and the association was tested using Chi square test. Results: The mean age group of patients included in the present study was 56.52 ± 11.3 years and the age group ranged from 32 to 76 years. The average duration of diabetes mellitus and metformin therapy were reported as 10.92±8.95 years and 8.66±7.24 years respectively. Vitamin B12 deficiency was seen in 49(40.83%)of the patients.When compared to other patients in the study population,patients with age greater than 50, duration of diabetes greater than 10 years, duration of metformin therapy greater than 5 years, and dose of metformin greater than 1000 mg/day had vitamin B12 deficiency.The association was found to be statistically significant (p0.05) with p values of 0.048,0.012,0.026,and 0.002, respectively.With diabetes for less than 10 years and more than 10 years, the mean serum levels of vitamin B12 were 183.518±94.75 and 152.384±36.26, respectively, and there was a significant correlation between the duration of diabetes exposure (p Value 0.004). Conclusion: Patients on metformin therapy frequently have vitamin B12 deficiency,especially those over the age of 50 years,with diabetes for longer than ten years, taking metformin for longer than five years, and receiving doses of more than 1000 mg/day. This strongly suggests routine screening for vitamin B12 in diabetic patients taking metformin.Before starting metformin,and afterwards on an annual basis,it is critical to screen for vitamin B12 insufficiency