Vitamin B12 deficiency in patients with type 2 diabetes mellitus using metformin and the associated factors in Saudi Arabia

Abstract

To assess the presence of vitamin B12 deficiency among metformin users and associated factors in patients with type 2 diabetes mellitus. Methods: An observational cross-sectional study was conducted with 307 diabetic patients in the primary health care centers at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia between October 2017 and January 2018. Face-to-face interviews were conducted with the participants, using a designed checklist. Results: The prevalence of vitamin B12 deficiency was (3.6%) and the majority of the sample had borderline B12 levels (66.1%). The vitamin B12 deficiency and borderline levels were strongly associated with the Original Article dose of metformin. Patients taking doses of metformin more than 1000 mg had lower levels of vitamin B12. The use of multivitamin and vitamin B complex was assessed, and it was found that there was a marked decrease in the prevalence of vitamin B12 deficiency in patients using vitamin B complex containing more than 200 mcg vitamin B12. Conclusion: Our findings show a low prevalence of vitamin B12 deficiency in type 2 diabetic patients taking metformin. The majority of the sample had borderline deficiency; therefore, additional investigation and management are required.

Evaluation of Serum B12 Levels among Patients with Type 2 Diabetes Mellitus

“…This suggests that as age, FBG and HbA1c levels increase, vitamin B12 levels decrease. These findings are consistent with those of a study by Appold et al 20 which attributed the correlation to malnutrition in older adults. However, they contrast with the results of a study by Alsaeed 21 which found a positive correlation, likely due to the inclusion of patients receiving vitamin B12 supplements.…”

Is metformin a possible treatment for diabetic neuropathy?

“…Since 1971, when malabsorption of vitamin B12 in diabetic patients with metformin was first reported, 80 numerous clinical trials and meta‐analyses have confirmed the association between metformin and low vitamin B12 levels. 81 , 82 , 83 , 84 , 85 , 86 , 87 Vitamin B12 is found in foods as a protein‐binding form and released under the action of gastric acid pepsin and trypsin after entering the digestive tract. Then the free vitamin B12 is bound by the intrinsic factor (IF, a glycosylated protein secreted by gastric parietal cells) forming IF‐vitamin B12 complex, which is eventually absorbed in the ileum.…”

“…Since 1971, when malabsorption of vitamin B12 in diabetic patients with metformin was first reported, 80 numerous clinical trials and meta‐analyses have confirmed the association between metformin and low vitamin B12 levels 81–87 . Vitamin B12 is found in foods as a protein‐binding form and released under the action of gastric acid pepsin and trypsin after entering the digestive tract.…”

Diabetes mellitus research in Saudi Arabia: A bibliometric study (2010-2021)

“…In all, one-fourth of the adult population is affected by DM, and the number is expected to more than quadruple by 2030. [ 1 2 3 4 5 ] The most concerning trend is the rise in DM prevalence in recent years, with a roughly tenfold increase in KSA during the previous30 years. [ 6 7 ] According to the World Health Organization, KSA has the second-highest DM rate in the Middle East and is seventh in the world.…”