Evaluation of serum vitamin b12 in elderly individuals with type 2 diabetes mellitus, with and without dementia, in relation to the use of metformin

BACKGROUND Metformin is considered as a cornerstone in the treatment of diabetes and is the most frequently prescribed first line therapy for individuals with T2DM. Metformin use in type 2 diabetes mellitus has shown to cause vitamin B12 (B12) deficiency. Besides these, B12 deficiency related neuropathy may mimic and/or aggravate the underlying diabetic neuropathy. Furthermore, there have been lack of consensus regarding the universal routine screening of serum B12 levels among metformin users with T2DM, and similar studies from India are also limited. So, we wanted to study the relationship between metformin use and serum B12 in T2DM patients. METHODS The study included a total of 104 subjects of which 52 are T2DM affected individuals who are only on metformin therapy for at least 3 months, served as cases and 52 are newly diagnosed T2DM age and sex matched individuals yet to be medically treated, served as controls. Their blood samples were collected to estimate vitamin B12 and other parameters. RESULTS The median B12 levels in cases 213.5 pg/mL (IQR 136.25-301.0) were found to be significantly lower (P < 0.05) when compared to median levels of controls 240 pg/mL (IQR 214-303.25). B12 levels also showed a significant fall in their levels with increasing duration of T2DM. CONCLUSIONS Metformin induced vitamin B12 deficiency plays a major role in developing life risks in T2DM patients. Routine screening and supplementation of B12 may be required in T2DM patients KEYWORDS Metformin, Type 2 Diabetes Mellitus, Vitamin B12

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Serum Vitamin B12 In Relation To Anemia And Neuropathy By MNSI Among Type 2 Diabetes Mellitus Adults On Metformin

10.26226/morressier.617c37317c09fc044a9751a9 ◽

2021 ◽

Author(s):

Tripti Saxena

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Vitamin B12 ◽

Serum Vitamin

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Vitamin B12 Deficit Status among Type 2 Diabetes Mellitus Patients - A Review

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/370 ◽

2021 ◽

Vol 10 (23) ◽

pp. 1794-1798

Author(s):

Lata Kanyal Butola ◽

Roshan Kumar Jha ◽

Ranjit Ambad ◽

Deepika Kanyal ◽

Jayshri Jankar

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Vitamin B12 ◽

Plasma Concentrations ◽

Serum Vitamin ◽

Positive Effects ◽

Long Term Treatment

Several studies have confirmed the increased incidence of vitamin B12 deficiency in patients with type 2 diabetes mellitus. Metformin is currently the most commonly used anti-diabetic drug, metformin being prescribed as first-line therapy for patients with type 2 diabetes mellitus (T2DM) worldwide. Other disorders including insulin resistance, such as polycystic ovary syndrome (PCOS), can also be treated with metformin. Metformin has positive effects on metabolism, weight loss, and vascular defence of carbohydrates, but it also has significant side effects. Patients on long-term treatment with metformin, for example, have been shown to be at risk of anemia. This may be because of a decrease in metformin-related vitamin B12. It is estimated that 30 percent of patients undergoing long-term metformin treatment have experienced vitamin B12 malabsorption, with a 14 percent to 30 percent reduction in serum vitamin B12 concentration. A critical nutrient for wellbeing is vitamin B12. It plays a significant role in the functioning and the production of red blood cells in the brain and nervous system. In addition to anemia, a deficiency of vitamin B12 may increase the severity of peripheral neuropathy in T2DM patients. In addition, since vitamin B12 is involved in the most critical homocysteine (Hcy) metabolism pathway, a decrease in vitamin B12 will increase plasma concentrations of Hcy, which in patients with T2DM and PCOS is closely linked to cardiovascular disease. Evaluating serum vitamin B12 levels will also provide an early diagnosis of the status of the deficiency. This will offer an incentive for harm caused by routine screening and early detection to be reversed. KEY WORDS Vitamin B12, Metformin, Diabetes Mellitus, Glycated Hb

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Effect of metformin on serum vitamin B12 level in patients with type 2 diabetes mellitus

International Journal of Diabetes in Developing Countries ◽

10.1007/s13410-014-0279-7 ◽

2015 ◽

Vol 35 (4) ◽

pp. 628-629 ◽

Cited By ~ 1

Author(s):

Mitra Niafar ◽

Behrad Jamali ◽

Nasrin LotfiBakhshaiesh ◽

Naser Aghamohadzadeh ◽

Nader D. Nader

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Vitamin B12 ◽

Serum Vitamin

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Correlation of vitamin B12 deficiency with metformin therapy in type 2 diabetes mellitus patients

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20196075 ◽

2020 ◽

Vol 7 (2) ◽

pp. 200

Author(s):

S. B. Nayyar ◽

Manbir Kaur Dhillon ◽

Sahiba Kukreja

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Vitamin B12 ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Metformin Therapy ◽

B12 Deficiency ◽

Group B

Background: Diabetes mellitus is an endocrine and metabolic disorder, characterized by hyperglycemia. Metformin is the first line pharmacotherapy recommended by ADA. It has been recognized that metformin use is associated with serum vitamin B12 deficiency. The objective of this study is to determine the prevalence of serum vitamin B12 deficiency among Indian patients with type 2 diabetes mellitus on metformin therapy compared to those who are not on metformin.Methods: Here, 90 patients of type 2 diabetes mellitus of both sexes were included in this cross-sectional study conducted from January 2018 to August 2019 in SGRDIMSR, Sri Amritsar. They were divided into two groups; Group A of 60 subjects of type 2 diabetes mellitus on metformin therapy >1 year and group B of 30 subjects of type 2 diabetes mellitus not on metformin or had stopped taking metformin 6 months back. Serum vitamin B12 levels were measured using a Chemiluminescence method. Data was statistically analysed.Results: The serum vitamin B12 levels were 190.02±90.75 pmol/l in group A (metformin users) and 586.9±243.69 pmol/l in group B (not metformin users) (p value=0.002). A significant negative correlation existed between the serum vitamin B12 and duration and dose of metformin use (r꞊ -0.676) and (r -0.855) by using Pearson’s correlation coefficient in group A.Conclusions: Metformin is associated with decrease in serum vitamin B12 levels. Annual screening of serum vitamin B12 is recommended for patients of type 2 diabetes mellitus who are on metformin therapy for longer duration and /or in higher doses.

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The vitamin B12 levels in type 2 diabetes mellitus patients on metformin and not on metformin

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20210270 ◽

2021 ◽

Vol 8 (2) ◽

pp. 165

Author(s):

Ramesh Dasarathan ◽

Rajendran Velayudham ◽

Haridoss Krishnan ◽

Senthilkumar S.

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Vitamin B12 ◽

Serum Vitamin ◽

Vitamin B12 Deficiency ◽

Metformin Therapy ◽

Significant Difference ◽

B12 Deficiency

Background: Type 2 diabetes mellitus (T2DM) is one of the major global public health concerns, metformin is one of the most widely used drugs and considered as first-line therapy for management of T2DM. Vitamin B12 malabsorption is observed in patients on metformin therapy leading to biochemical and clinical vitamin B12 deficiency. The aim of the current study was to assess the relationship between metformin therapy and development of vitamin B12 deficiency.Methods: Current observational cross sectional study was conducted at Madras medical college and Rajiv Gandhi Government general hospital. Serum vitamin B12 and other blood investigation parameters of T2DM patients, on metformin therapy for long duration (6 months or more than 2 years) were measured and correlated with vitamin B12 levels of T2DM patients not on metformin therapy. Patients were given appropriate treatment and were regularly followed up.Results: Results of the current study findings depicted that significant difference was observed in percent haemoglobin, total blood cells, platelet count, mean corpuscular volume (MCV) and albumin values of patients on metformin therapy when compared to patients who were not on metformin therapy. Study findings also revealed that substantial difference in vitamin B12 deficiency was observed in T2DM patients based on the duration of metformin therapy.Conclusions: Current study revealed that, metformin therapy for 2 years or more, can lead to significant vitamin B12 deficiency which is also associated with macrocytosis. It was concluded that longer the duration of metformin therapy, more significant would be vitamin B12 deficiency.

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Serum vitamin B12 and homocysteine levels in type 2 diabetes patients on metformin

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20203602 ◽

2020 ◽

Vol 7 (9) ◽

pp. 1376

Author(s):

Kunal Lala ◽

Divya Lala ◽

Saurabh Duggad

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Vitamin B12 ◽

Serum Vitamin ◽

Study Groups ◽

P Value ◽

Haemoglobin A1c ◽

Metformin Group

Background: Metformin is reported to induce vitamin B12 deficiency, however India data is limited. The present study was conducted to assess the vitamin B12 and homocysteine levels among type 2 diabetes mellitus patients taking metformin.Methods: The present observational study included 60 patients with diabetes mellitus, 30 patients on metformin therapy (at least 6 months) and 30 patients not on metformin use. Laboratory investigations were sent for vitamin B12, homocysteine and HbA1c.Results: Mean vitamin B12 level was 159.67±95.73 and 510.73±206.18 pmol/l in the metformin and non-metformin group respectively (p value <0.001). Serum homocysteine levels were found to significantly higher in the metformin group as compared to non-metformin group (17.39±4.97 vs 14.43±2.43 µmol/l, p value <0.01). Folate levels were similar in the two study groups (22.71±3.67 vs 27.54±2.83 mmol/L). Haemoglobin A1c levels were significantly higher in the metformin group as compared to non-metformin group (7.85±0.97 vs 7.25±0.80 respectively). Triglycerides, high density lipoprotein and total cholesterol levels were found to be similar between the two study groups. However, low density lipoproteins were significantly higher in the metformin group as compared to the non-metformin group (3.7±0.92 vs 3.4±0.86 mmol/l).Conclusions: Our results show metformin use in type 2 diabetes mellitus patients was associated with significantly lower vitamin B12 levels and significantly high homocysteine levels.

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