Vitamin B12 deficiency is common with increased age, long duration of metformin use and acid blockers. Albai O, Timar B, Paun DL, Sima A, Roman D, Timar R. Diabetes Metab Syndr Obes. Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. information and will only use or disclose that information as set forth in our notice of Unauthorized use of these marks is strictly prohibited. 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. Vitamin B12 deficiency is both underdiagnosed and undertreated [ 7, 8 ]. Mayo Clinic does not endorse any of the third party products and services advertised. Because there is a possibility that taking vitamin B12 pills will not be the right choice for you. the unsubscribe link in the e-mail. Search for Similar Articles How common is vitamin B-12 deficiency? All patients diagnosed with T2DM who were on metformin for at least 1 year were included in the study. The use of acid blockers was also associated with vitamin B12 deficiency (p=0.012). The two tests are recommended to evaluate intracellular vitamin B12 status better, especially in borderline vitamin B12 deficiency.Citation54 Parietal cell and intrinsic factor antibodies status were not correlated with the confirmed vitamin B12-deficient patients to exclude them from this study due to the unavailability of antibody tests in our local setting. 2021 Jul 15;12(7):916-931. doi: 10.4239/wjd.v12.i7.916. 2016;17:44, 21. Abstract Background Metformin is first-line therapy for patients with diabetes. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. In short, the long-term deficiency of vitamin B12 causes serious symptoms like depression, delusion, difficulty in walking, loss of mobility, seizures, and dementia. Molecular Aspects in the Potential of Vitamins and Supplements for Treating Diabetic Neuropathy. The majority were females (67.2%) and those with type 2 diabetes (92.9%). Metformin-induced vitamin B12 deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy in the patient with diabetes. A single copy of these materials may be reprinted for noncommercial personal use only. An official website of the United States government. 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. Mellitus Diabetic patients can easily develop a B12 deficiency as they are at a higher risk. Delusions. WebLong-term low vitamin B12 levels caused by pernicious anemia can affect your nervous system. Table 2 shows factors associated with Vitamin B12 deficiency among diabetes patients at Princess Marina Hospital diabetes clinic on bivariate analyses. The median (IQR) duration since the diagnosis of diabetes was 6 (212) years, and 89.5% of participants were on metformin. Vitamin B12 deficiency resulting from metformin use has been demonstrated in multiple studies. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes J Korean Med Sci. Journal of Korean Medical Science 2014. Diabetes Obes Metab. 2- Metformin containing Glumetza and Glucophage for treatment of diabetes type 2. Diabetic neuropathy was evaluated by patient record, nerve conduction and Michigan test for the diagnosis of diabetic neuropathy. Taking omeprazole (Prilosec), lansoprazole (Prevacid) or 17541761. We were not also able to draw a solid conclusion on the association of vitamin B12 deficiency with vitamin B12 supplementation since we do not have enough number of patients who had vitamin B12 levels. The mean serum vitamin B12 level of all 16 patients was 558.46 318.01 pg/mL (range of 1741288 pg/mL). 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. Also, a single-centre nature of the study limits the generalisation of the study findings. Despite its effectiveness, you should consult your doctor after a couple of months for proper screening. In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. Type 2 Diabetes Vitamin B12 Deficiency Hyperhomocysteinemia: Due to high cost for investigation serum homocysteine level was measured only in 6 patients and serum vitamin B12 level (cheaper test) was measured in 14 patients with prior permission from Ethics Committee. Please enable it to take advantage of the complete set of features! Taylor & Francis does not sell reprints or permissions for this article. The most commonly used oral hypoglycemic agent was gliclizide only in 138 (38.4%) of patients. Facts & Comparisons eAnswers. The mean age of these 16 patients was 53.8 14.26 (range of 3584 years old). Long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. Well, vitamin B12 does not play a role in the management of blood glucose levels. One standard first-line treatment for diabetes is metformin, which was reported to increase the risk for vitamin B12 deficiency. 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. 3- How much vitamin B12 can you take in metformin therapy for diabetics? Please enable it to take advantage of the complete set of features! Vitamin B12, being a water-soluble vitamin, is also known as cobalamin. Zhang YH, Guo W, Zeng T, Zhang S, Chen L, Gamarra M, Mansour RF, Escorcia-Gutierrez J, Huang T, Cai YD. 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). 405412. [25] There have been no studies that explored the knowledge and perceptions of physicians on vitamin B12 screening. Of all the patients 17 were already considered to be deficient in B12. 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. We wanted to determine the prevalence of vitamin B12 deficiency in metformin-treated type 2 diabetes mellitus patients. Would you like email updates of new search results? Vitamin B12. 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. Metab., 101 (2016), pp. Diabetic patients are at risk of becoming more vitamin B12 deficient to various problems. 2015 Dec;41(6):550-5. doi: 10.1016/j.encep.2015.07.004. 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. Damio C, Rodrigues A, Pinheiro M, Cruz Filho R, Cardoso G, Taboada G, et al Prevalence of vitamin B12 deficiency in type 2 diabetic patients using metformin: A cross-sectional study Sao Paulo Med J. 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). 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 Methods: We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. Vitamin B12 is an essential vitamin, and deficiency generally occurs with inadequate absorption or lack of dietary intake. The high consumption of meat among the Botswana population may explain the lower prevalence of vitamin B12 in our population than in other African settings. How much vitamin B12 should a diabetic take? In the US, it is currently believed that adults with type 2 diabetes that are over 50 should take 2.4 g of synthetic vitamin B12 daily either in supplement form or in fortified food. The Steno Diabetes In a journal article on plant-based vitamin B12 sources, researchers have claimed that purple larval and mushrooms are very healthy and rich sources of B12. 2016;42:31627, 15. Alshammari, Amal N.1,; Iqbal, Rafay1; Baksh, Iqra Peer2, 1Department of Family and Community Medicine, Joint Program, Riyadh, Saudi Arabia, 2Department of Dermatology, General Practitioner, Riyadh, Saudi Arabia, Address for correspondence: Dr. Amal N. Alshammari, Department of Family and Community Medicine, Joint Program, Resident R 3, Riyadh, Saudi Arabia. In most cases, this depletion takes place 3 to 4 months after starting this therapy. These can include dementia, disorientation, neurological damage, gait disturbance and anemia. Vegans and vegetarians are more prone to its deficiency just because vitamin B12 is not present in plants. MeSH The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Table 1 shows the clinicodemographic profile of all patients. Mayo Clinic does not endorse companies or products. 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. 2017;9:725, 24. Viollet B, Guigas B, Garcia N, Leclerc J, Foretz M, Andreelli F. Cellular and molecular mechanisms of metformin: An overview Clin Sci. You dont have to take Vitamins supplements if you are facing a minor B12 deficiency. A study shows that vitamin B12 increases due to the inductive effect of metformin by increasing calcium intake. 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. Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. Vitamin B-12 supplements also are recommended for women who are pregnant or breastfeeding exclusively and follow vegetarian or vegan diets. Diabetes mellitus (DM) is a chronic metabolic disease with increasing prevalence worldwide. 34 The prevalence of anemia and mean corpuscular volume did not differ between T2DM-met patients with and without B12 deficiency (23.1% versus 31.3% and 89.4 fl versus 89.0 fl, respectively). Liu et al. Kumthekar AA, Gidwani HV, Kumthekar AB. 2014;349:g5226, 26. He received his medical degree from University of Southern California and has been in practice around 8 years. Left untreated, a vitamin B-12 deficiency can lead to anemia, fatigue, muscle weakness, intestinal problems, nerve damage and mood disturbances. 2006;35:2001, 6. Metformin and the gastrointestinal tract Diabetologia. Epub 2016 Apr 26. Hunt A, Harrington D, Robinson S. Vitamin B12 deficiency Bmj. [23], Vitamin B12 deficiency screening is recommended for diabetic patients on long-term treatment with biguanides including metformin.
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