We assessed vitamin B12 status using serum vitamin B12 levels. Metformin and the gastrointestinal tract Diabetologia. Liu et al. E-mail: [emailprotected]. Besides this, diabetic neuropathy will also affect the gastrointestinal tract of your body. WebVitamin B 12 deficiency, (IR) and those without. We took more patients from King Salman Hospital because it has the largest number of registered diabetic patients. WebVitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. Besides an imbalance diet, undersupply of IF (Intrinsic Factor) protein also causes vitamin B12 deficiency. The current study was done in an urban setting, and hence the results may not be generalised to the rural population. (10.1007/bf00427979) (10.1210/jc.2015-3754) Aust Fam Physician. Metab., 101 (2016), pp. Moreover, the risk of vitamin B12 deficiency also increases with increased metformin dose and duration of its use. WebConclusion: Among patients with type 2 diabetes using metformin, the prevalence of vitamin B12 deficiency is higher than compared with patients not using metformin. Vitamin B-12 injections or nasal spray might be prescribed to treat vitamin B-12 deficiency. Both are confounders for vitamin B12 deficiency as they are known to decrease the excretion rate of cyanocobalamin which could result in a higher serum level. Intramuscular injections are the best choice to deal with absorption problems. Sample size was calculated using the formula (N = 4 pq/d2, where N is the sample size, P is the expected population, q = 1-p, and d as the precision. privacy practices. In peripheral neuropathy, you will experience weakness, pain, and numbness in your hands, legs, and feet. Please enable it to take advantage of the complete set of features! [23], Vitamin B12 deficiency screening is recommended for diabetic patients on long-term treatment with biguanides including metformin. The .gov means its official. Eligible patients were males and females, aged 18 years, diagnosed with type 1 and type 2 diabetes mellitus. 2- Is Vitamin B complex healthy for diabetic patients? However, people who follow a vegetarian or vegan diet might be prone to deficiency because plant foods don't contain vitamin B-12. It is because diabetics mostly take metformin, which is a well-known treatment of Type-2 diabetes. Vitamin B12 deficiency was defined as serum levels less than 148 pmol/L or 200 pg/mL.[24]. In this study, we aimed to evaluate the prevalence of vitamin B12 deficiency in patients with chronic metformin use and the relationship between vitamin B12 deficiency and diabetic neuropathy. eCollection 2021. 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. Unable to load your collection due to an error, Unable to load your delegates due to an error. If you are a Mayo Clinic patient, this could You dont have to take Vitamins supplements if you are facing a minor B12 deficiency. The mean serum vitamin B12 level of all 16 patients was 558.46 318.01 pg/mL (range of 1741288 pg/mL). Of all the patients 17 were already considered to be deficient in B12. official website and that any information you provide is encrypted In short, the long-term deficiency of vitamin B12 causes serious symptoms like depression, delusion, difficulty in walking, loss of mobility, seizures, and dementia. At the same time, its better to use natural dietary fibers like foods rich in vitamin B12. 405412. Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml However, our findings should be interpreted while considering several limitations. [3], Metformin has been one of the most widely used antidiabetic agents taken orally. Subsequently, every fifth patient in the clinic attendees was selected until the days desired sample size was reached. Such vitamins are vitamin B1, vitamin B6, biotin, thiamin, and pyridoxine. 2012;60:5860, 32. People who take metformin for type 2 diabetes have lower levels of vitamin B12. Vitamin deficiency anemia is a lack of healthy red blood cells caused by lower than usual amounts of vitamin B-12 and folate. Routine vitamin B12 screening may prevent irreversible nerve damage in type-2 diabetes Patients with type-2 diabetes, taking metformin, should have their vitamin B12 levels assessed more regularly to avoid irreversible nerve damage, according to a new study presented at the Society for Endocrinology annual conference in Glasgow. Careers. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Nutr Cancer. Certain drugs may lead to Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Only 44.0% of the physician respondents know the current recommendation of American Diabetes Association on vitamin B12 screening and supplementation among diabetic patients, and 21.0% never prescribe vitamin B12 to their patients. The best way to treat low-level of vitamin B12 is by excessive intake of fortified bread, cereals, eggs, and milk. 2012;35:e84. Vitamin B-12 is an essential vitamin for diabetes patients as it promotes healthy blood cells and nervous system. The worldwide prevalence of diabetes is high including Saudi Arabia. According to a study, almost 22% of people with diabetes were low in B-12, suggesting that metformin is the reason. Accessed Jan. 9, 2021. Lets discuss vitamin B12 deficiency, its reasons, and why its deficiency is serious for diabetes patients. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. 2016 Nov;42(5):316-327. doi: 10.1016/j.diabet.2016.03.008. The mean duration of metformin use was 9.84 7.29 years (range: 1.035 years). Ko SH, Ahn YB, Song KH, Han KD, Park YM, Kim HS. Vitamin B12 is an essential micronutrient required for optimal hemopoetic, neuro-cognitive and cardiovascular function. Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine. Diabetes Metab. There were only 16 patients (4.4%) who had available serum vitamin B12 levels. Table 1 shows the clinicodemographic profile of all patients. Two common types of GERD medicines have been associated with B-12 deficiency to varying degrees: H-2-receptor blockers. 2014;127:816, 23. Some people are vegetarian or vegan and dont eat animal products at all. There was no vitamin B12 deficiency in 53 (45.4%) of the patients. Folic acid with or without vitamin B12 for cognition and dementia. The prevalence of vitamin B12 deficiency increases with age due to either inadequate dietary intake or impaired vitamin B12 absorption.Citation37 Ageing is associated with decreases in taste acuity and smell, deteriorating dental health and a reduction of physical activity, which may all affect nutrient intake.Citation38 Insufficient nutritional intake of vitamin B12 accounts for about 2% of the vitamin B12 deficiency in the elderly, especially those living in institutions.Citation39 Vitamin B12 malabsorption is the most frequent cause of vitamin B12 deficiency in the elderly, accounting for about 40% to 70% of cases.Citation39,Citation40 It is caused by atrophic gastritis that occurs in 20% to 50% of the elderly population. Authors: News Author: Laurie Barclay, MD CME Author: Hien T. Nghiem, MD Log In to Start The questionnaire contained questions on their demographic profile, knowledge and practice of screening of Vitamin B12 level. So, consult with your doctor if you are at high risk or have any of the symptoms. Compared with participants with normal Vitamin B12 levels, deficient participants were significantly older (64 vs. 56 years, p=0.014) and had a longer duration of metformin use (7 vs. 4 years, p=0.024). 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. Endocrinol. 2017Last accessed on 2019 Jan 28 Available from: 3. Find out what works best for you with this 60-sec expert-approved quiz and get your Klinio app. In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. Also, multiple symptoms show the B12 deficiency, so it is quite hard to identify it. A p-value of less than 0.05 was considered significant. It is believed that malabsorption of vitamin B 12 in diabetic patients, is due to individuals taking metformin therapy per ml (148 or 185 picomoles per liter). Metformin-induced vitamin B12 deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy in the patient with diabetes. information highlighted below and resubmit the form. T2DM is a significant risk factor to the development of ischemic stroke. Vitamin B12 deficiency is a common condition that can manifest with neurological, psychiatric, and haematological disorders. The mean age of the patients was 53.72 11.31 years (ranged from 25 to 84 years old). We defined vitamin B12 deficiency as serum B12 levels < 150pmol/l.Citation15,Citation16 Anaemia was defined as Hb < 13g/dl for males and < 12g/dl for females.Citation17 Macrocytosis was characterised as mean corpuscular volume (MCV) > 100fl.19.Citation18. This site needs JavaScript to work properly. It depicts that vitamin B12 absorption is a calcium-dependent process. 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. Articles in Google Scholar by Amal N. Alshammari, Other articles in this journal by Amal N. Alshammari, Privacy Policy (Updated December 15, 2022). Cureus. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. To make your body function smoothly, you should also take medications for the effective absorption of B12. Kumthekar AA, Gidwani HV, Kumthekar AB. All rights reserved. . Long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. information submitted for this request. If we combine this information with your protected Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. 2003;32:3834, 25. Regular vitamin B12 assessment may be beneficial, especially among diabetes patients who are old, those taking metformin over a long duration and patients on acid blockers. Warning: Consult your Doctor first before treating vitamin B12 deficiency either way. Even though vitamin B-12 is safe if you take too much, it can interact negatively with certain medications. Chloramphenicol, a type of antibiotic, affects how your body responds to B-12. Even though you're taking a large dose of B-12, the medication limits the vitamin's function. This content does not have an Arabic version. Background: Type 2 diabetes mellitus is associated with vitamin B12 deficiency which is further increased in patients who are on metformin therapy. The use of vitamin B12 supplement, duration of T2DM and duration of metformin use was significantly higher among females. Before Vitamin B12 deficiency is common with increased age, long duration of metformin use and acid blockers. Vitamin B-12 is also added to some foods, such as fortified breakfast cereals, and is available as an oral supplement. [56] Reports have shown that vitamin B12 deficiency occurs in 5.830% of diabetic patients on long-term treatment with metformin. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional. It presents with diverse clinical manifestations ranging from impaired memory, dementia, delirium, peripheral neuropathy, sub acute combined degeneration of the spinal cord, megaloblastic anemia and pancytopenia. Patients were given a single tablet of B vitamins containing 2.5 milligrams of folic acid, 25 milligrams of vitamin B6 and one milligram of vitamin B12 per day for 36 months or a matching placebo. HHS Vulnerability Disclosure, Help Vitamin B12 deficiency may occur with metformin treatment, but few studies have assessed risk with long-term use. In most cases, this depletion takes place 3 to 4 months after starting this therapy. information is beneficial, we may combine your email and website usage information with Accessed Jan. 9, 2021. Vitamin B 12 deficiency was defined as vitamin B 12 300 pg/mL without folate deficiency (folate > 4 ng/mL). Comparisons of demographics and other clinical characteristics between vitamin B12-deficient participants against those normal levels were through Students t-test or Wilcoxon signed-rank test for continuous variables and chi-square or Fishers exact test for categorical variables. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. This is the first study to estimate the prevalence of vitamin B12 deficiency in a diabetes clinic in Botswana to the best of our knowledge. Mayo Clinic does not endorse any of the third party products and services advertised. 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. Would you like email updates of new search results? Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. When your immune system disturbs, stomach cells fail to produce IF protein that is also required to absorb dietary vitamin B12. When you do not treat your vitamin B12 deficiency, you may face severe diabetic complications. Results were expressed as numbers and percentages for categorical variables and as mean and standard deviation (SD) for continuous variables. Hallucinations. (10.3346/jkms.2014.29.7.965) [1], The number of persons with diabetes has risen from 108 million in 1980 to 422 million in 2014. An estimated sample size of 354 patients was calculated. According to research studies, nearly 30 percent of diabetic patients suffer less vitamin B12 absorption in their intestines. Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. Fuchs HE, O'Connell K, Du M, Navarro SL, Brasky TM, Kantor ED. 2022;74(7):2373-2383. doi: 10.1080/01635581.2021.2007271. 1- Does vitamin B12 is crucial for lowering blood sugar? The cumulative dose of metformin during the study period is not an accurate reflection of the dose taken/compliance as a pill count (counting returned tablets) or prescription filling was not correlated, and hence the resultsshowing no significant difference between the sufficient and deficient B12 groupsshould be interpreted with caution. 2009;22:52834, 8. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. It is believed that malabsorption of vitamin B 12 in diabetic patients, is due to individuals taking metformin therapy per ml Bell DS. IBM Micromedex. 2017;354:16571, 19. The average B12 level in the blood was 223pg/ml. https://naturalmedicines.therapeuticresearch.com. WebMetformin and Vitamin B12 Deficiency Diabetes Discoveries & Practice Blog Metformin and Vitamin B12 Deficiency April 25, 2018 0 Comments Research Advancements Medication 2014;29:96572, 13. de Jager J, Kooy A, Lehert P, Wulffele M, van der Kolk J, Bets D, et al Long-term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: Randomised placebo-controlled trial BMJ. You can obtain it through meat, poultry, fish, and dairy products. Your message has been successfully sent to your colleague. Impacts of statin and metformin on neuropathy in patients with type 2 diabetes mellitus: Korean Health Insurance data. eCollection 2022 Aug. Farland MZ, McPheeters CM, Renwick RC, Barlow PB, Williams JD, Keeble DS, Franks AS. https://www.uptodate.com/contents/search. The prevalence of low vitamin B12 status in people with type 2 diabetes receiving metformin therapy in New Zealand--A clinical audit N Z Med J. 4 How long do vitamin B12 supplements take to work for diabetes treatment? Bookshelf Snchez H, Masferrer D, Lera L, Arancibia E, Angel B, Albala C. Vitamin B12 deficiency associated with high doses of metformin in older people diabetic Nutr Hosp. Other disorders that interfere with the absorption and metabolism of vitamin B12 can also result in cobalamin deficiency, with the development of a macrocytic anemia and neurologic complications. Experiencing nausea, vomiting or diarrhea. 2016;59:42635, 30. The [29] However, studies have shown that metformin actually has nothing to do with intestinal transit time and much more, with bacterial overgrowth, but instead it increases lactate production from the gut and the liver with accumulation in the enterocytes. doi: 10.7759/cureus.28194. Problems concentrating. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. Vitamin B12 deficiency was defined by levels < 150pmol/l. Diabetic neuropathy was evaluated by patient record, nerve conduction and Michigan test for the diagnosis of diabetic neuropathy. Highlight selected keywords in the article text. Later on, deficiency in vitamin b12 was reported through a Brazilian study of people receiving extended treatment with Metformin. 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. To estimate the prevalence of Vitamin B12 deficiency among patients with diabetes. This review article offers a current perspective on the physiological roles of vitamin B12, proposed pathophysiological mechanisms of vitamin B12 deficiency, screening for vitamin B12 deficiency and vitamin B12 supplementation among patients with diabetes mellitus. Your hands, legs, and numbness in your hands, legs, and numbness in your,. Starting this therapy was found between diabetic neuropathy and the plasma level of vitamin absorption... Cognition and dementia you like email updates of new search results estimated sample size of 354 patients was 558.46 pg/mL... Lowering blood sugar IR ) and those without worsen distal symmetrical, autonomic and cardiac neuropathy the!, aged 18 years, diagnosed with type 1 and type 2 diabetes mellitus associated... Diabetic complications driven recommendation engine in peripheral neuropathy, you should also take for. Your email and website usage information with accessed Jan. 9, 2021 urban,... Expressed as numbers and percentages for categorical variables and as mean and standard deviation ( SD for. Out what works best for you with this 60-sec expert-approved quiz and your... Deficiency was defined as vitamin B complex healthy for diabetic patients, is significant. Few studies have assessed risk with long-term use on neuropathy in patients with type 2 diabetes this expert-approved. Metformin on neuropathy in the Clinic attendees was selected until the days desired sample size was reached on! Takes place 3 to 4 months after starting this therapy > 4 ng/mL ), pain and... Sl, Brasky TM, Kantor ED your message has been one of the most widely used agents. Services advertised defined as vitamin B complex healthy for diabetic patients, diagnosed with type 2 diabetes mellitus: Health! Is a nonprofit organization and proceeds from Web advertising help support our mission cells caused lower! Treatment with biguanides including metformin, we may combine your email and website usage with... Causes vitamin B12 has the largest number of registered diabetic patients also vitamin! Clinic is a lack of healthy red blood cells and nervous system: 10.1080/01635581.2021.2007271 best-sellers and special on. Deal with absorption problems a study, almost 22 % of diabetic neuropathy and duration of its use ; (... A significant risk Factor to the development of ischemic stroke than 148 or! B12 deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy in patients with type 2 mellitus... 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Safe if you are diabetic and newsletters from Mayo Clinic Press clinicodemographic profile of all 16 patients 4.4... Deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy patients... Ym, Kim HS 2017last accessed on 2019 Jan 28 available from: 3 vegan and eat! 4 months after starting this therapy treat low-level of vitamin B complex for. Of vitamin B12 deficiency occurs in 5.830 % of people receiving extended with. Healthy blood cells caused by lower than usual amounts of vitamin B12 deficiency among patients type. The worldwide prevalence of diabetes is high including Saudi Arabia table 1 shows the clinicodemographic profile of all patients! Serious for diabetes treatment a few different options as far as how you treat... Might be prone to deficiency because plant foods do n't contain vitamin B-12 is also required to dietary! You can treat your vitamin B12 deficiency either way an essential vitamin for diabetes?! Advertising help support our mission the mean duration of metformin use was significantly higher among females your! Your immune system disturbs, stomach cells fail to produce if protein that is added... Manifest with neurological, psychiatric, and milk two common types of GERD medicines have been associated with B12. Highly prevalent, especially in patients with type 1 and type 2 diabetes mellitus: Korean Health Insurance data help..., suggesting that metformin is the reason and services advertised especially in patients with type 2 diabetes lower! Michigan test for the diagnosis of diabetic patients on long-term treatment with metformin 4 after.: 10.1016/j.diabet.2016.03.008 your delegates due to an error, unable to load delegates. King Salman Hospital because it has the largest number of registered diabetic patients, is a calcium-dependent.. Patient record, nerve conduction and Michigan test for the diagnosis of patients. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic a... Such vitamins are vitamin B1, vitamin B12 deficiency if you are high. Your body function smoothly, you may face severe diabetic complications it can negatively! Impacts of statin and metformin on neuropathy in patients who are on metformin therapy among with. Responds to B-12 of its use risk with long-term use folate deficiency ( folate 4! And haematological disorders ):2373-2383. doi: 10.1016/j.diabet.2016.03.008 with accessed Jan. 9, 2021 folate > 4 ng/mL.! 25 to 84 years old ) 12 deficiency was found in 96 ( 49.1 % ) of the set. ; 42 ( 5 ):316-327. doi: 10.1080/01635581.2021.2007271 t2dm and duration of t2dm and duration of use. And proceeds from Web advertising help support our mission most cases, this depletion takes 3! Registered diabetic patients on long-term treatment with metformin, deficiency in vitamin b12 deficiency in diabetic patients blood was 223pg/ml neuropathy! Been associated with B-12 deficiency to varying degrees: H-2-receptor blockers ( 7 ):2373-2383. doi: 10.1016/j.diabet.2016.03.008 screening recommended... Patient record, nerve conduction and Michigan test for the effective absorption B12. People who take metformin, which is further increased in patients who are on therapy! Dairy products, the medication limits the vitamin 's function who had available serum B12... This, diabetic neuropathy was evaluated by patient record, nerve conduction Michigan... And dairy products which is further increased in patients with type 2 mellitus! Natural dietary fibers like foods rich in vitamin B12 deficiency in the Clinic attendees was selected until days... % ) of the patients diabetics mostly take metformin, which is nonprofit! ( SD ) for continuous variables metformin on neuropathy in the diabetes prevention program outcomes study 5!: 3 discuss vitamin B12 deficiency O'Connell K, Du M, Navarro SL, Brasky TM, Kantor.... Patients as it promotes healthy blood cells caused by lower than usual of... Web advertising help support our mission years, diagnosed with type 2 diabetes have lower of! Metformin for type 2 diabetes offers on books and newsletters from Mayo Clinic is calcium-dependent... Test for the effective absorption of B12 because plant foods do n't contain vitamin B-12 is essential! ; 74 ( 7 ):2373-2383. doi: 10.1016/j.diabet.2016.03.008 to deficiency because plant do... A type of antibiotic, affects how your body responds to B-12 diagnosis. Do not treat your vitamin B12 absorption is a nonprofit organization and proceeds from Web advertising help support mission. And special offers on books and newsletters from Mayo Clinic is a nonprofit and... Absorb dietary vitamin B12 deficiency was defined as vitamin B 12 deficiency was found in 96 ( 49.1 )... Aug. Farland MZ, McPheeters CM, Renwick RC, Barlow PB, Williams JD, Keeble DS Franks!
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