2006;35:2001, 6. We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. (10.2337/dc11-1582) Epub 2021 Nov 24. WebVitamin B12 deficiency is related to a number of comorbidities, such as peripheral neuropathy and megaloblastic anemia. All patients diagnosed with T2DM who were on metformin for at least 1 year were included in the study. 2012;35:e84. IBM Micromedex. 2016;134:4739, 22. The mean age of the patients was 53.72 11.31 years (ranged from 25 to 84 years old). 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. Treatment Of B12 Deficiency In Diabetes Patients. Clipboard, Search History, and several other advanced features are temporarily unavailable. Encephale. Diabetes patients are often exposed to metformin, as it is an oral medication for hyperglycemia. In anemic conditions, the body automatically produces antibodies against the vitamin B12 carrier, i.e., Intrinsic Factor (IF). Facts & Comparisons eAnswers. 2016;42:31627, 15. Fuchs HE, O'Connell K, Du M, Navarro SL, Brasky TM, Kantor ED. sharing sensitive information, make sure youre on a federal Low vitamin B12 levels were found in 7.3% (95% CI: 4.0-12%) of patients. You can boost the absorption of vitamin B12 in your body by taking the following medications: 1- An antibiotic- known as chloramphenicol. Its all about the vitamin B12 that gets absorbed into our blood from the small intestine. Eligible patients were males and females, aged 18 years, diagnosed with type 1 and type 2 diabetes mellitus. Such vitamins are vitamin B1, vitamin B6, biotin, thiamin, and pyridoxine. eCollection 2022 Aug. Farland MZ, McPheeters CM, Renwick RC, Barlow PB, Williams JD, Keeble DS, Franks AS. Vitamin B-12 injections or nasal spray might be prescribed to treat vitamin B-12 deficiency. Though all vegetables and plants dont have vitamin B12, there are still some plant-based sources. Ahmed M, Muntingh G, Rheeder P. Vitamin B12 deficiency in metformin-treated type-2 diabetes patients, prevalence and association with peripheral neuropathy BMC Pharmacol Toxicol. 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. Clin Diabetes. Table 1 shows the clinicodemographic profile of all patients. The use of vitamin B12 supplement was significantly higher among females (p < 0.001). 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. Vitamin B12, being a water-soluble vitamin, is also known as cobalamin. Estimation of Serum Vitamin B12 Levels Among the Elderly Population of Wardha City: A Cross-Sectional Study. Vitamin B12 deficiency is a common condition that can manifest with neurological, psychiatric, and haematological disorders. 2016;17:44, 21. 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. -, Reinstatler L, Qi YP, Williamson RS, Garn JV, Oakley GP Jr. Association of biochemical B12 deficiency with metformin therapy and vitamin B12supplements: the National Health and Nutrition Examination Survey, 19992006. 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). Before The average B12 level in the blood was 223pg/ml. One standard first-line treatment for diabetes is metformin, which was reported to increase the risk for vitamin B12 deficiency. Curr Diab Rep. 2021 Aug 27;21(9):31. doi: 10.1007/s11892-021-01397-1. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. 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. Accessed Jan. 9, 2021. 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 form was piloted on five medical records before using it. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Unauthorized use of these marks is strictly prohibited. Keywords: Sharma R, Wanjari MB, Raut A, Gujar S, Gledina A, Kantode VV, Munjewar PK. Of all the patients 17 were already considered to be deficient in B12. The https:// ensures that you are connecting to the Meat consumption in Botswana increased by 0.3% between 1966 and 2011, primarily driven by beef, poultry and pork consumption.Citation22 The variation in the cut-off values for vitamin B12 deficiency across studies may also explain the wide variations in B12 deficiency from 5.8% to 52% in studies worldwide.Citation5,Citation6,Citation8,Citation10,Citation19,Citation20,Citation2325 In some studies, individuals with borderline vitamin B12 levels were further screened for evidence of elevated serum methylmalonic acid or homocysteine concentrations.Citation2 In this way, patients with borderline vitamin B12 levels were further categorised into those with or without vitamin B12 deficiency. Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind. 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. doi: 10.7759/cureus.28194. WebMetformin and Vitamin B12 Deficiency Diabetes Discoveries & Practice Blog Metformin and Vitamin B12 Deficiency April 25, 2018 0 Comments Research Advancements Medication Hyperhomocysteinaemia and vitamin B12 deficiency are often detected in patients affected with diseases associated with neuropathy such as diabetes, 66 alcoholism, 67 Parkinsons disease (treated with L-dopa), 68 or HIV infection. In diabetes, blood glucose level goes low beyond a certain limit. The site is secure. Molecular Aspects in the Potential of Vitamins and Supplements for Treating Diabetic Neuropathy. In previous studies, a significant association between vitamin B12 deficiency and low haemoglobin concentration was also reported.Citation44,Citation45 Inadequate vitamin B12 results in ineffective DNA synthesis and impaired erythropoiesis, which may account for significantly low haemoglobin among vitamin B12 deficient patients.Citation46. A large percentage of physicians are not aware of the current recommendations of the American Diabetic Association (ADA) regarding vitamin B12 supplementation and screening. 2- Is Vitamin B complex healthy for diabetic patients? FOIA Generally, vitamin B12 supplements start showing their effect after 48 to 72 hours of the initial dose. https://www.uptodate.com/contents/search. While in anemia, the number of healthy red blood cells to carry out oxygen depletes. When IF binds with Vitamin B12, a vitamin B12-IF complex forms, this complex plays a vital role in the absorption of vitamin B12 in your body. Bethesda, MD 20894, Web Policies Lastly, genetic and environmental differences could be the other factors that explain the variation in the prevalence of vitamin B12 deficiency in different settings.Citation26 Several single-nucleotide polymorphisms (SNPs) in multiple genes interact with environmental factors to cause vitamin B12 deficiency.Citation27, Consistent with previous studies, metformin use was associated with vitamin B12 deficiency in our patients.Citation19 In the present study, vitamin B12 deficient patients had a longer duration of metformin use, as reported in other studies.Citation19,Citation28 Levels of serum B12 are inversely associated with the dose and duration of metformin use.Citation5,Citation10,Citation2831 Reports have shown a decrease in vitamin B12 levels as early as four months after initiation of metformin.Citation10,Citation31 The exact mechanism of this association is unknown but is ascribed to the binding of the hydrophobic tail of biguanide to the hydrocarbon core of membranes. 1 The prevalence of vitamin B12 deficiency in diabetes mellitus The site is secure. In this study an inverse correlation was found between diabetic neuropathy Warning: Consult your Doctor first before treating vitamin B12 deficiency either way. Additional data, including demographic characteristics were collected. There were 206 (56.7%) males and 157 (43.3%) females, and 337 (92.8%) were Saudis. Your body absorbs only as much as it needs, and any excess passes through your urine. September 5, 2016. From a sampling frame of a list of all patients attending the diabetes clinic during the study period, we used a systematic random sampling of 10 participants each day. When you do not treat your vitamin B12 deficiency, you may face severe diabetic complications. People who don't get enough vitamin B-12 may have a higher risk of neuropathy and other nervous system (neurological) problems. In the human body, the small intestine is the part where absorption of Vitamin B12 takes place. 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. Vitamin supplementation in disease prevention. World J Diabetes. WebVitamin B 12 deficiency, (IR) and those without. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. [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. Some error has occurred while processing your request. We did not exclude patients with chronic kidney disease (especially those with eGFR < 50) and those on salicylates. your express consent. eCollection 2021. The median (IQR) duration since the diagnosis of diabetes was 6 (212) years, and 89.5% of participants were on metformin. The data collection was done in the clinic using a data extraction form. It was thought that the use of PPI contributes to vitamin B12 deficiency,[32] which may add to the vitamin B12 deficiency status of T2DM patients. Michalak SS, Wolny-Rokicka E, Nowakowska E, Michalak M, Gil L. J Diabetes Res. -. government site. A linear regression model was used to evaluate variables that correlated with vitamin B12 levels and diabetic neuropathy. Nervo M, Lubini A, Raimundo F, Moreira Faulhaber G, Leite C, Fischer L, et al Vitamin B12 in metformin-treated diabetic patients: A cross-sectional study in Brazil Rev Assoc Med Bras. Another serious thing that may happen to vitamin B12 deficient people is loss of smell and taste sensations. Long AN, Atwell CL, Yoo W, Solomon SS. 965972. The average B12 level in the blood was 223pg/ml. We chose the four hospitals according to availability of Vitamin B12 test. 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. -, de Jager J, Kooy A, Lehert P, Wulffel MG, van der Kolk J, Bets D, Verburg J, Donker AJ, Stehouwer CD. We recommend screening and treating vitamin B12 deficiency in patients with diabetes who are on long-term metformin and acid blockers. Moreover, low levels of B12 can cause homocysteine (high levels of amino acid), leading to stroke and cardiovascular disorders. 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. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Advertising and sponsorship opportunities. Bell DS. WebVitamin B12 is a water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function. Articles in Google Scholar by Amal N. Alshammari, Other articles in this journal by Amal N. Alshammari, Privacy Policy (Updated December 15, 2022). Some people suffer from serious symptoms such as shortness of breath, dizziness, fatigue, and a fast heartbeat. (10.1136/bmj.c2181) Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Recommendations for Practical Use of Metformin, a Central Pharmacological Therapy in Type 2 Diabetes. 2016 Mar;39(3):305-14. doi: 10.1007/s40618-015-0365-9. Medical management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: A consensus statement of the American diabetes association and the European association for the study of diabetes Diabetes Care. The [3], Metformin has been one of the most widely used antidiabetic agents taken orally. According to research studies, nearly 30 percent of diabetic patients suffer less vitamin B12 absorption in their intestines. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes: A systematic review and meta-analysis Diabetes Metab. 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. A total of 46 (46.0%) were family physicians, 29 (29.0%) were internal medicine doctors, and 25 (25.0%) were from other specialties. Registered in England & Wales No. You may also suffer from diabetic neuropathy due to a lack of vitamin B12. privacy practices. Never take a supplement or injection at your own decision. Besides this, diabetic neuropathy will also affect the gastrointestinal tract of your body. Categorical variables appear as counts and percentages. 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. Also, add a good amount of green leafy vegetables to your diet. The mean duration of metformin use was 9.84 7.29 years (range: 1.035 years). Am J Clin Nutr. WebConclusion: The prevalence of vitamin B12 deficiency is considerable among diabetic patients on metformin therapy. Vitamin B12 level was lower in type 2 diabetic patients on metformin compared to those on other oral anti-diabetic drugs, but without significant deficiency. Design: Secondary analysis from the DPP/DPPOS. National Library of Medicine Search for Similar Articles Methylcobalamin. One such major complication is damage to nerves due to very high blood glucose levels for a long period. If a patients mood is low at the same time, this can easily be interpreted as depression. Mellitus Diabetic patients can easily develop a B12 deficiency as they are at a higher risk. Vitamin B12 affects the dynamics of autonomic nervous system and its deficits has been linked to cardiovascular autonomic neuropathy therefore, vitamin B12 deficiency was Health experts usually advise diabetic patients to intake a dose of supplement depending upon the deficiency level in the body. 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