Small intestinal transit in diabetics.

Scarpello, J. H. B.; Greaves, Michael; Sladen, G. E.

doi:10.1136/bmj.2.6046.1225

Cited by 67 publications

(30 citation statements)

References 5 publications

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“…The mechanism of this assumed idiosyncratic effect has been unclear and, therefore, a subject of controversy. Some evidence supported the hypothesis that metformininduced B 12 malabsorption is due to enhanced bacterial overgrowth, especially because diabetic patients are known to exhibit alterations in small bowel motility as well as bacterial overgrowth (5)(6). It may also be speculated that metformin could alter bacterial flora through an effect on motility and/or facilitation of bacterial growth by delaying absorption of glucose (4).…”

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confidence: 79%

Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin.

et al. 2000

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OBJECTIVE -Of patients who are prescribed metformin, 10-30% have evidence of reduced vitamin B 12 absorption. B 12 -intrinsic factor complex uptake by ileal cell surface receptors is known to be a process dependent on calcium availability. Metformin affects calciumdependent membrane action. The objective of this study was to determine the magnitude and mechanism of the reduction in serum vitamin B 12 after metformin administration. RESEARCH DESIGN AND METHODS-A comparative study design was employed using 2 groups (metformin and control). A total of 21 patients with type 2 diabetes received sulfonylurea therapy; 14 of these 21 patients were switched to metformin. Monthly serum total vitamin B 12 measurements and holotranscobalamin (holoTCII) (B 12 -TCII) were performed. After 3 months of metformin therapy, oral calcium supplementation was administered.RESULTS -Serial serum vitamin B 12 determinations revealed a similar decline in vitamin B 12 and holoTCII. Oral calcium supplementation reversed the metformin-induced serum holoTCII depression.CONCLUSIONS -Patients receiving metformin have diminished B 12 absorption and low serum total vitamin B 12 and TCII-B 12 levels because of a calcium-dependent ileal membrane antagonism, an effect reversed with supplemental calcium.

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confidence: 79%

Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin.

et al. 2000

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“…It has been shown that metformin could induce Vitamin B 12 malabsorption by enhancing bacterial overgrowth, altering bacterial flora in enteric canal, and binding to the Vitamin B 12 -intrinsic factor (IF). This malabsorption ultimately leads to a reduction of serum Vitamin B 12 [41][42][43][44][45]. Hence, some researchers were calling attention to the monitoring of Vitamin B 12 concentration in the diabetic patients treated with metformin, and suggested Vitamin B 12 supplementation could be considered in patients with Vitamin B 12 deficiency [3,46,47], although some authors still doubt the clinical significance of this reduction [48,49].…”

Section: Discussionmentioning

confidence: 99%

Metformin Treatment and Homocysteine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Zhang

et al. 2016

Value in Health

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Abstract:The aim of this systematic review is to assess whether metformin could change the concentration of serum homocysteine (Hcy) with and without simultaneous supplementation of B-group vitamins or folic acid. A literature search was conducted in PubMed, EmBase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials (RCTs) reporting the concentration of serum Hcy in metformin-treated adults. Meta-analysis was applied to assess the association between metformin and the changes of Hcy concentration. Twelve publications were included in this study. In the overall analysis, metformin administration was not statistically associated with the change of Hcy when compared with the control treatment (mean difference (MD), 0.40 µmol/L; 95% confidence interval (CI), −0.07~0.87 µmol/L, p = 0.10). In the subgroup analysis, metformin was significantly associated with an increased concentration of Hcy in the absence of exogenous supplementation of folic acid or B-group vitamins (MD, 2.02 µmol/L; 95% CI, 1.37~2.67 µmol/L, p < 0.00001), but with a decreased concentration of serum Hcy in the presence of these exogenous supplementations (MD, −0.74 µmol/L; 95% CI, −1.19~−0.30 µmol/L, p = 0.001). Therefore, although the overall effect of metformin on the concentration of serum Hcy was neutral, our results suggested that metformin could increase the concentration of Hcy when exogenous B-group vitamins or folic acid supplementation was not given.

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“…These disorders have been ascribed mainly to gastrointestinal autonomic neuropathy (SCARPELLO et al, 1976;CLARKE et al, 1979;FELDMAN et al, 1984;GRANNEMAN and STRICKER, 1984;KASSANDER, 1958;SCOTT and ELLIS, 1980). However, diabetic changes include alteration of the intrinsic nervous system of the alimentary tract, e.g., reduced number of Auerbach's plexus and degenerated intrinsic axons, as well as extrinsic nerves to the gastrointestinal tract (CLARKE et al, 1979;HOSKING et al, 1978).…”

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confidence: 99%

Compliance changes of the gastrointestinal tract in streptozotocin-induced diabetic rats.

Karakida

Homma

1989

Jpn.J.Physiol

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In order to elucidate diabetic gastrointestinal disorders, we measured the length, diameter, volume, and intraluminal pressure of the isolated segments of the duodenum, jejunum, ileum, and proximal colon during injection of Tyrode's solution into them, as well as wet weight. Wet weight of the stomach and of each intestinal segment of 3 cm length were similar between normal and diabetic preparations, except the duodenum. Wet weight of the diabetic duodenum was significantly heavier than that of normal. However, capacity of all diabetic gastrointestinal segments was significantly larger than that of normal ones, even after corrected for wet weight (ml/g wet weight). During saline injection, normal intestinal segments were more easily distended longitudinally than circumferentially. Contrarily, diabetic ones were distended more circumferentially than normal, as well as longitudinally. Pressure-volume relationships showed that pressure inside of the diabetic gastrointestinal tract increased much more moderately than that of normal one according to volume increase during saline injection. Similarly, tension inside of diabetic intestinal segments increased much more moderately than that of normal ones. Chord and slope compliance of diabetic gastrointestinal tract was generally larger than those of normal one. Histologically, there are no remarkable differences in cross-sectional area between normal and diabetic intestinal segments after usual fixation without intraluminal fixative injection. However, diabetic segments were much more remarkably dilated than normals were, when fixed after fixative injection. Greater compliance or distensibility of the diabetic gastrointestinal tract seemed to be one basic ground for dilatation, atony, larger appearance, transit delay, and motile disorders of the diabetic gastrointestinal tract.

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Small intestinal transit in diabetics.

Cited by 67 publications

References 5 publications

Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin.

Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin.

Metformin Treatment and Homocysteine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Compliance changes of the gastrointestinal tract in streptozotocin-induced diabetic rats.

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