Vitamin B12 Deficiency in Diabetic Patients on Metformin Therapy: A cross-sectional study from Oman

Al-Hamdi, Ahmed; Al-Gahhafi, Mohammed; Al-Roshdi, Shihab; Jaju, Sanjay; Al-Mamari, Ali; Mahrezi, Abdulaziz M. Al

doi:10.18295/squmj.2020.20.01.013

Cited by 16 publications

(22 citation statements)

References 15 publications

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“…[ 2 3 20 ] Metformin is perennially reported as a pharmacological cause of vitamin B12 deficiency. [ 4 5 6 7 8 9 10 21 ] The underlying mechanism is mostly controversial; proposed contributors have included competitive inhibition or inactivation of B12 absorption, alterations in intrinsic factor levels, gut bacterial flora, gastrointestinal motility, or ileal morphological structure, and interaction with the cubulin endocytic receptor. [ 21 22 ] Metformin is also shown to impair calcium-dependent membrane activity in the ileum, including uptake of the B12-intrinsic factor complex.…”

Section: Discussionmentioning

confidence: 99%

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Serum vitamin B12 status of patients with type 2 diabetes mellitus on metformin

Alam

Kamrul-Hasan²,

Kalam

2021

Journal of Family Medicine and Primary Care

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Background: Metformin use is a known cause of B12 deficiency in patients with type 2 DM (T2DM). Diabetic peripheral neuropathy (DPN) often has clinically indistinguishable clinical features of B12 deficiency-induced peripheral neuropathy (PN). Objective: The present study aims to assess serum vitamin B12 levels in patients with T2DM on metformin. Subjects and Methods: This cross-sectional study was conducted at a specialized endocrine outpatient clinic in Cumilla, Bangladesh, over six months from January 2020 to June 2020. Non-pregnant adults (≥18 years age) receiving metformin for T2DM for at least six months were evaluated for PN and assessed for serum B12 levels. Results: Among 90 subjects evaluated, 28 (31.1%) had B12 deficiency and 6 (6.7%) had borderline B12 deficiency; 56 (62.2%) had normal B12 levels. Study subjects with subnormal B12 used metformin for a longer duration [8.5 (7.0-14.0) vs. 5.0 (2.25-10.0) years, median (IQR), P = 0.006], gram-years of metformin use was higher in them [12.0 (7.9-14.0) vs. 5.75 (2.0-13.6) years, median (IQR), P = 0.005] and they had a higher mean corpuscular volume [85.9±7.2 vs. 82.4±6.4 fL, mean±SD, P = 0.020] compared to those having normal B12 levels. Serum B12 levels had a strong negative correlation with duration of metformin use and gram-years of metformin use. B12 status did not influence the presence and severity of PN. Conclusions: A considerable number of patients with T2DM have subnormal B12 levels. Periodic screening for serum vitamin B12 level may be of clinical benefit in such patients.

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Section: Discussionmentioning

confidence: 99%

“…in 1969 and has been demonstrated by many researchers since then. [ 4 5 6 7 8 9 ] The reported prevalence of metformin-related vitamin B12 deficiency is widely variable (5--40%) in the available literature. [ 8 10 ]…”

Section: Introductionmentioning

confidence: 99%

Serum vitamin B12 status of patients with type 2 diabetes mellitus on metformin

Alam

Kamrul-Hasan²,

Kalam

2021

Journal of Family Medicine and Primary Care

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“…From the databases, I identified 7257 records; finally, 11 studies were included in this review [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Figure 1 shows the results of the screening and selection process.…”

Section: Resultsmentioning

confidence: 99%

“…The full results of the search are shown in Table 1 . Of the 11 scientific papers, 4 were conducted in the Kingdom of Saudi Arabia [ 16 , 18 , 19 , 21 ], 2 in Palestine [ 14 , 22 ], and 1 each in Libya [ 12 ], Lebanon [ 13 ], Qatar [ 15 ], Oman [ 20 ], and the United Arab Emirates (UAE) [ 17 ]. To the best of my knowledge, with this review, I am the first to explore the association between metformin use and vitamin B12 deficiency in individuals with T2DM in Arab countries.…”

Section: Resultsmentioning

confidence: 99%

Vitamin B12 Deficiency in Patients with Diabetes on Metformin: Arab Countries

Alhaji

2022

Nutrients

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Background: Diabetes is a global pandemic, especially in Arab countries. Aim: The goal of this study was to review the published studies that were conducted to determine the relationship between metformin treatment for type 2 diabetes mellitus (T2DM) and vitamin B12 deficiency and to identify possible complications in this relationship. Methods: I searched for all relevant studies published in English before 2020 on the PubMed and Web of Knowledge databases using the following terms: “metformin”, “vitamin B12”, “neuropathy”, “diabetes mellitus”, and Middle Eastern countries. Results: Eleven studies were included in this review which indicated an association between taking metformin and B12 deficiency in patients with T2DM in Arab countries. This B12 deficiency was found to be negatively associated with the dose and duration of metformin therapy. The physician’s knowledge of current ADA recommendations regarding supplementation with and screening of the B12 level for T2DM patients on metformin was also found to have an effect. Conclusion: Metformin therapy is associated with B12 deficiency among people with T2DM in Arabic countries. Thus, diabetes must be managed in compliance with current guidelines and recommendations, and B12 levels must be routinely monitored, particularly in those who have been long-term takers of metformin, to ensure the suitable management of diabetes and its complications.

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“…14 Published literature and case reports have documented biochemical and clinical vitamin B12 deficiency to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. [15][16][17] Metformin use has been unequivocally demonstrated as the prime factor associated with vitamin B12 deficiency among patients with T2DM. Cross sectional, retrospective, and longitudinal observational studies revealed evidence of vitamin B12 malabsorption in patients who had been treated with metformin for 3 months or in patients on longterm metformin therapy.…”

Section: Introductionmentioning

confidence: 99%

The vitamin B12 levels in type 2 diabetes mellitus patients on metformin and not on metformin

et al. 2021

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Background: Type 2 diabetes mellitus (T2DM) is one of the major global public health concerns, metformin is one of the most widely used drugs and considered as first-line therapy for management of T2DM. Vitamin B12 malabsorption is observed in patients on metformin therapy leading to biochemical and clinical vitamin B12 deficiency. The aim of the current study was to assess the relationship between metformin therapy and development of vitamin B12 deficiency.Methods: Current observational cross sectional study was conducted at Madras medical college and Rajiv Gandhi Government general hospital. Serum vitamin B12 and other blood investigation parameters of T2DM patients, on metformin therapy for long duration (6 months or more than 2 years) were measured and correlated with vitamin B12 levels of T2DM patients not on metformin therapy. Patients were given appropriate treatment and were regularly followed up.Results: Results of the current study findings depicted that significant difference was observed in percent haemoglobin, total blood cells, platelet count, mean corpuscular volume (MCV) and albumin values of patients on metformin therapy when compared to patients who were not on metformin therapy. Study findings also revealed that substantial difference in vitamin B12 deficiency was observed in T2DM patients based on the duration of metformin therapy.Conclusions: Current study revealed that, metformin therapy for 2 years or more, can lead to significant vitamin B12 deficiency which is also associated with macrocytosis. It was concluded that longer the duration of metformin therapy, more significant would be vitamin B12 deficiency.

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Vitamin B12 Deficiency in Diabetic Patients on Metformin Therapy: A cross-sectional study from Oman

Cited by 16 publications

References 15 publications

Serum vitamin B12 status of patients with type 2 diabetes mellitus on metformin

Serum vitamin B12 status of patients with type 2 diabetes mellitus on metformin

Vitamin B12 Deficiency in Patients with Diabetes on Metformin: Arab Countries

The vitamin B12 levels in type 2 diabetes mellitus patients on metformin and not on metformin

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