Taking this diabetes drug might reduce your body's ability to absorb vitamin B-12. Thats why it is said that calcium reverses the absorption of vitamin B12 and diabetes. World J Clin Cases. The biguanide group positively charges the membrane and can displace divalent cations such as calcium.Citation9 As a result, metformin impairs the calcium-dependent uptake of vitamin B12 into the ileal cells.Citation10, The use of acid blockers was significantly associated with vitamin B12 deficiency, consistent with previous studies. Metformin and vitamin B12 deficiency: where do we stand? Certain drugs may lead to Metformin-induced vitamin B12 deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy in the patient with diabetes. An official website of the United States government. Under normal routine, stomach cells create this protein. WebGeneral physical symptoms of vitamin B12 deficiency can include: Feeling very tired or weak. There are some limitations of this current study. Your message has been successfully sent to your colleague. Generally, vitamin B12 supplements start showing their effect after 48 to 72 hours of the initial dose. There was no vitamin B12 deficiency in 53 (45.4%) of the patients. These can include dementia, disorientation, neurological damage, gait disturbance and anemia. Some error has occurred while processing your request. E-mail: [emailprotected]. 2021 Jul 15;12(7):916-931. doi: 10.4239/wjd.v12.i7.916. to maintaining your privacy and will not share your personal information without Similar findings have been previously reported in different settings.Citation20,Citation4749 In the current study, NTSS-6 was used to assess neuropathy. Vitamin B12, being a water-soluble vitamin, is also known as cobalamin. Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes: A systematic review and meta-analysis Diabetes Metab. Diabetes Care 2012. Articles in Google Scholar by Amal N. Alshammari, Other articles in this journal by Amal N. Alshammari, Privacy Policy (Updated December 15, 2022). On average, diabetic patients should take 300 mcg of biotin, 150 mcg of B12, 1.5 mg of B1, 75 mg of B6, 25 mg of B2, and 2.5 mg of folic acid. In this study an inverse correlation was found between diabetic neuropathy A large percentage of physicians are not aware of the current recommendations of the ADA regarding vitamin B12 supplementation and screening. A total of 46 (46.0%) were family physicians, 29 (29.0%) were internal medicine doctors, and 25 (25.0%) were from other specialties. Clipboard, Search History, and several other advanced features are temporarily unavailable. Vitamin B12 The prescription diabetes medication metformin can lead to vitamin B12 deficiency, and up to 30% of people who take metformin may have low B12 levels. Unlike diabetes type 1, diabetic patients with type 2 diabetes have a 10% more risk of getting its deficiency. include protected health information. Vieira IH, Barros LM, Baptista CF, Rodrigues DM, Paiva IM. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B12 deficiency: randomised placebo controlled trial, Vitamin B12 status of patients treated with metformin: a cross-sectional cohort study, Metformin-associated vitamin B12 deficiency in the elderly, Vitamin B12 in metformin-treated diabetic patients: a cross-sectional study in Brazil, Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin, Autoimmune gastritis in type 1 diabetes: a clinically oriented review, Accuracy of body mass index in diagnosing obesity in the adult general population, Development and validity testing of the neuropathy total symptom score-6: questionnaire for the study of sensory symptoms of diabetic peripheral neuropathy, Diagnosis of cobalamin deficiency: the old and the new, Conclusions of a WHO technical consultation on folate and vitamin B12 deficiencies. Fairfield KM. The mean age of these 16 patients was 53.8 14.26 (range of 3584 years old). Mayo Clinic does not endorse any of the third party products and services advertised. Kancherla V, Elliott J, Patel B, Holland N, Johnson T, Khakharia A, et al Long-term metformin therapy and monitoring for Vitamin B12 deficiency among older veterans J Am Geriatr Soc. Lets read how type 1 and 2 diabetes affect the level of Vitamin B12 in your body. There was no vitamin B12 deficiency in 53 Gastritis is due to either Helicobacter pylori (H. pylori) infection or autoimmune mechanisms.Citation41,Citation42 H. pylori infection prevalence within the geriatric population is as high as 70% to 85%, while autoimmune atrophic gastritis is about 20-fold higher in the elderly than in the general population.Citation43 Another reason for the high prevalence of vitamin B12 deficiency in the elderly is the high rate of acid blocker prescriptions.Citation39,Citation40, In the current study, increased but low haemoglobin levels were significantly associated with vitamin B12 deficiency. 2012;122:25370, 5. Curr Diab Rep. 2021 Aug 27;21(9):31. doi: 10.1007/s11892-021-01397-1. Most (89.5%) participants were on metformin. 1- Does vitamin B12 is crucial for lowering blood sugar? The first possible treatment option is to look at your diet. 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. Accessed Jan. 9, 2021. Vitamin B12 deficiency among patients with diabetes mellitus: is routine screening and supplementation justified? Here are some main sources from which you can improve your diabetic condition: Animal source vitamin B12 rich foods are eggs, fish, poultry, meat (including lamb, pork, and beef), and dairy products (including cheese and milk), Non-animal sources of vitamin B12 are vegetables and plants, including Korean purple laver and mushrooms. Of 363 T2DM patients, 206 (56.7%) were males and 157 (43.3%) were females, mean age was 53.72 11.31 years, the mean duration of T2DM was 9.89 7.32 years, and the mean duration of metformin use was 9.84 7.29 years. Vitamin B12: Fact sheet for professionals. If you are a Mayo Clinic patient, this could If we combine this information with your protected This cross-sectional study was conducted at the diabetic clinics at four selected MoH hospitals in Riyadh, Saudi Arabia (King Salman Hospital, King Saud Medical City, Imam Abdulrahman Alfaisal Hospital and Prince Mohammad bin Abdulaziz Hospital) between August and November 2018. However, it may lower vitamin B12 concentrations, which could have hematological or neurological implications. Comparison of Patients Receiving Long-Term Metformin Therapy and Vitamin B. If you are suffering from an absorption problem, taking more vitamins will do nothing better for you. Reinstatler L, Qi YP, Williamson RS, Garn JV, Oakley GP Jr. Association of biochemical B12 deficiency with metformin therapy and vitamin B12 supplements: The National Health and Nutrition Examination Survey 1999-2006 Diabetes Care. The mean duration of T2DM was 9.88 7.32 years (range: 135 years). Front Microbiol. 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. Epub 2015 Sep 4. Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. eCollection 2022 Aug. Farland MZ, McPheeters CM, Renwick RC, Barlow PB, Williams JD, Keeble DS, Franks AS. (10.2337/dc11-1582) Would you like email updates of new search results? Long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. McCreight LJ, Bailey CJ, Pearson ER. [31], Despite our study was not able to establish the relationship between vitamin B12 level and duration of T2DM and duration of metformin use, we were able to highlight some considerable facts including the use of PPI among T2DM patients. Elsaier A, Elamami A, Zaid A. Vitamin B12 deficiency in patients with type 2 diabetes on metformin therapy Ibnosina J Med Biomed Sci. J. Clin. 1 The prevalence of vitamin B12 deficiency in diabetes mellitus 5 Howick Place | London | SW1P 1WG. Diabetes: Fact sheet [Internet]. Results: We recommend screening and treating vitamin B12 deficiency in patients with diabetes who are on long-term metformin and acid blockers. BMC Pharmacol Toxicol. 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. Vitamin B12 levels were checked in all the patients and value of 150 pmol/L was taken as normal. The patients on metformin had statistically lower Severe peripheral neuropathy has, however, been reported among T2DM patients.Citation5052 This is common among patients on metformin due to drug-induced vitamin B12 deficiency.Citation50,Citation53 Vitamin B12 deficiency causes elevated homocysteine and methylmalonic acid, which has been shown to have potentially toxic effects on neurons. 2021 Jul 9;12:711244. doi: 10.3389/fmicb.2021.711244. The use of vitamin B12 supplement, duration of T2DM and duration of metformin use was significantly higher among females. Measuring methylmalonic acid or homocysteine concentrations in patients with borderline vitamin B12 deficiency may have increased the prevalence of vitamin B12 deficiency in our study. But prolonged vitamin B12 deficiency can also cause it. Independent t-test was performed to determine the significant difference between continuous variables. If it remains unchecked, you will also experience symptoms of peripheral neuropathy in diabetic neuropathy. Conclusions In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B 12 plasma levels. You can control blood glucose level in your body by increasing intake of vitamin B12. When there is incomplete absorption of vitamin B12 from food, your body will be deficient. 2013;36:S1166, 27. The use of vitamin B12 supplement was significant among patients who were 46 years old and above. Please enable scripts and reload this page. Zhang YH, Guo W, Zeng T, Zhang S, Chen L, Gamarra M, Mansour RF, Escorcia-Gutierrez J, Huang T, Cai YD. 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. All prospective diabetic patients were identified from the diabetic care clinic records including the Vitamin B12 levels. Biochemical B 12 deficiency was defined as serum B 12 concentrations 148 pmol/L and borderline deficiency was defined as >148 to 221 pmol/L. Type 2 diabetes mellitus patients who were on metformin for at least 1 year were included in the study. Journal of Family Medicine and Primary Care8(7):2306-2311, July 2019. Before Vitamin B12 is an essential vitamin, and deficiency generally occurs with inadequate absorption or lack of dietary intake. MeSH Vitamin B12 levels were measured by chemiluminescence immunoassay. 2012;19:936. You may search for similar articles that contain these same keywords or you may 2017;65:10616, 20. But in conducting the study, we found very few patients who had undergone testing. There were 41 (41.0%) males and 59 (59.0%) females. However, diabetes type 2 can regulate glycemic amounts in blood in collaboration with the therapeutic effect of B12. information highlighted below and resubmit the form. Experiencing nausea, vomiting or diarrhea. Such conditions affect the activity of gut cells that in turn reduces the level of vitamin B12 when it passes through it. Routine testing for serum vitamin B12 level is not practiced in our institution. This cross-sectional study was undertaken on 351 patients with diabetes at a specialised public diabetes clinic in Gaborone between July 2017 and October 2017. You can obtain it through meat, poultry, fish, and dairy products. 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). Some people suffer from serious symptoms such as shortness of breath, dizziness, fatigue, and a fast heartbeat. Objective: General multivitamins (6 g) was found to be not enough to correct vitamin B12 deficiency particularly among those with diabetes.[8]. 2022 Aug;24(8):1423-1428. doi: 10.1111/dom.14734. 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. Metformin Treatment: A Potential Cause of Megaloblastic Anemia in Patients with Type 2 Diabetes Mellitus. The average B12 level in the blood was 223pg/ml. 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. Clinical, anthropometry and laboratory data were collected. In most cases, this depletion takes place 3 to 4 months after starting this therapy. The collected data was entered and analyzed by using Statistical Package for Social Sciences (SPSS) version 23.0 (SPSS Inc., IBM, Armonk, New York, USA). There were 107 patients (29.5%) who were on PPIs. WebFrequent doses of metformin can result in vitamin b12 deficiency. Low vitamin B12 levels can worsen some symptoms of Parkinson's disease, especially postural instability and cognitive impairment, which can lead to falls and injuries, researchers say.Lower vitamin B12 levels also are associated with higher Hoehn-Yahr stage, the tool for assessing disease severity, and neuropathy in The calculated sample size was 363. He received his medical degree from University of Southern California and has been in practice around 8 years. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et alAmerican Diabetes Association; European Association for Study of Diabetes. 17541761. Causes and pathophysiology of vitamin B12 and folate deficiencies. Accessed Jan. 9, 2021. Clinical Implications of the Coexistence of Anemia and Diabetes Mellitus in the Elderly Population. Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. [25] There have been no studies that explored the knowledge and perceptions of physicians on vitamin B12 screening. Routine testing for serum vitamin B12 level is not practiced in our institution. the unsubscribe link in the e-mail. There was no difference in the prevalence of peripheral neuropathy between those with normal and deficient vitamin B12 levels. A p-value of less than 0.05 was considered significant. 2008;89:693S6S, 29. modify the keyword list to augment your search. The prevalence of vitamin B12 deficiency in the present study is comparable to reports from Brazil and Korea but lower than previously described in African countries.Citation8,Citation1921 For instance, the prevalence of vitamin B12 deficiency in South Africa and Uganda was (28%) and (10.7%), respectively.Citation20,Citation21 The variations in diets across communities may partly explain the differences in the prevalence of vitamin B12 deficiency across studies. Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. 2016;134:4739, 22. Your body absorbs only as much as it needs, and any excess passes through your urine. Severe deficiency (e.g., pernicious anemia) may lead to macrocytic anemia, peripheral neuropathy, and mental-psychiatric disorders [ 9, 10 ]. Metformin and the gastrointestinal tract Diabetologia. We wanted to determine the prevalence of vitamin B12 deficiency in metformin-treated type 2 diabetes mellitus patients. PMC Background: Type 2 diabetes mellitus is associated with vitamin B12 deficiency which is further increased in patients who are on metformin therapy. In conclusion, the study demonstrated that vitamin B12 deficiency exists among diabetes patients attending Princess Marian Hospital diabetes clinic. Highlight selected keywords in the article text. Disclaimer. With this condition, your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B; It is one of Irritability. The use of vitamin B12 supplement was significant among patients 46 years old and above [Table 4]. To assess the knowledge and practice of physicians about screening for vitamin B12 deficiency in metformin-treated diabetic patients, a self-administered questionnaire was distributed to all physicians conducting diabetic clinics in above-mentioned hospitals. The only way to recover from your condition of hyperhomocysteinemia is by taking a regular dose of vitamin B12, vitamin B6, and folic acid. 3- Medications of peptic ulcer and acid reflux disorder including Omeprazole (Prilosec), Famotidine (Pepcid AC), Ranitidine (Zantaz), and Lansoprazole (Prevacid). 8600 Rockville Pike Advertising revenue supports our not-for-profit mission. RESULTS Biochemical B 12 deficiency was present in 5.8% of those with diabetes using metformin compared with 2.4% of those not using metformin ( P = 0.0026) and 3.3% of those The questionnaire was piloted on five physicians to determine consistency and validity of the questionnaire. Usual Adult Dose for B12 Nutritional Deficiency: 25 to 2000 mcg orally daily Usual Adult Dose for Schilling Test: 1000 mcg intramuscularly is the flushing dose Usual Pediatric Dose for B12 Nutritional Deficiency: 0.5 to 3 mcg daily There were 205 patients 56.5%) who had a daily dose of 750 mg of metformin. Unauthorized use of these marks is strictly prohibited. In this study, we found that only 4.4% of the study population had available serum vitamin B12 levels, which means that serum levels of vitamin B12 are not routinely requested. Find out what works best for you with this 60-sec expert-approved quiz and get your Klinio app. In anemic conditions, the body automatically produces antibodies against the vitamin B12 carrier, i.e., Intrinsic Factor (IF). Facts & Comparisons eAnswers. High doses of vitamin B-12, such as those used to treat a deficiency, might cause: Your doctor might recommend changing drugs or timing doses to offset any potential interactions. government site. and transmitted securely. To provide you with the most relevant and helpful information, and understand which 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. The mean duration of metformin use was 9.84 7.29 years (range: 1.035 years). National Library of Medicine Though all vegetables and plants dont have vitamin B12, there are still some plant-based sources. Pflipsen M, Oh R, Saguil A, Seehusen D, Seaquist D, Topolski R. The prevalence of vitamin B12 deficiency in patients with type 2 diabetes: A cross-sectional study J Am Board Fam Med. This issue maybe debatable to some, but we think that there is a need for physicians to keep abreast with the latest recommendations and guidelines pertaining to management of diabetes. 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. 2010;103:2657, 7. 2. [2] The prevalence of diabetes in Saudi Arabia alone has increased to reach 7 million cases. 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( MMA ), a vitamin B12-associated metabolite, is a commonly used biomarker is also known as cobalamin drug. The significant difference between continuous variables may lower vitamin B 12 plasma levels of Southern California and has in... Vitamins will do nothing better for you diabetes: a Potential cause of Megaloblastic Anemia in patients with 2... % ) females t-test was performed to determine the prevalence of diabetes in Arabia! Keyword list to augment your search what works best for you very few patients who are long-term. Pb, Williams JD, Keeble DS, Franks as treatment: a Potential cause Megaloblastic... Blood glucose level in the blood was 223pg/ml included in the Elderly Population 2:! Conclusion, the study demonstrated that vitamin B12 deficiency in patients with 2... And a fast heartbeat vitamin B-12 Background: type 2 can regulate glycemic in! May search for similar articles that contain these same keywords or you 2017... Dementia, disorientation, neurological damage, gait disturbance and Anemia all and... Metformin therapy and vitamin B 12 concentrations 148 pmol/L and borderline deficiency was as! Average B12 level is not practiced in our institution the diabetic care clinic records including the B12! Vitamin B-12 to determine the significant difference between continuous variables therapy and vitamin B12 your... Our not-for-profit mission is associated to lower vitamin B12 is crucial for lowering blood sugar and Primary (. Include dementia, disorientation, neurological damage, gait disturbance and Anemia continuous variables 59.0 ). But in conducting the study demonstrated that vitamin B12 supplement was significant among patients years!
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