scholarly journals Infra-Clinical Vitamin B12 Deficiency and Microangiopathic Profile, is this a New Risk Factor in Type 2 Diabetics? Algerian Experience

2018 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Risk Factor ◽  
Peripheral Neuropathy ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Biological Entity ◽  
Diabetic Patients ◽  
Significant Difference ◽  
Emerging Risk ◽  
B12 Deficiency

Introduction: Type 2 diabetes has multifactorial complications, in which hyperhomocysteinemia is an emerging risk factor that may be secondary to various conditions such as vitamin B12 deficiency, which appears oftenly as an asymptomatic setting and less specific in diabetics. Vitamin B12 deficiency definition has been revisited because its level does not reflect the intracellular status of vitamin B12, and an intracellular cofactor must be included systematically. Subclinical deficiency of vitamin B12 has recently been identified as a new clinic-biological entity that can affect micro and macro-angiopathic complications of diabetes indirectly through hyperhomocysteinemia. Materials and methods: 40 diabetic patients were screened for an infra-clinicalvitaminB12 deficiency subdivided into two groups each containing 16 patients, the first group having a deficit and the second having a normal level of vitamin B12. They were compared according to the frequency of micro-antipathy (retinopathy, nephropathy, peripheral neuropathy). Results: No significant difference was found for the different microangiopathic lesions; nevertheless the subclinical deficit seems to be a risk factor for peripheral neuropathy. Conclusion: In this study with a very modest sample. We attempted to approach the link between the borderline deficit of vitamin B12 and micro-angiopathic complications. In these results, even though the risk trend does not seem to be developing, the prospects for more extensive studies, both prospective and fundamental, should be encouraged.

scholarly journals Prevalence of vitamin B12 deficiency in type 2 diabetic patients using metformin: a cross-sectional study

2016 ◽  
Vol 134 (6) ◽  
pp. 473-479 ◽  
Author(s):  
Charbel Pereira Damião ◽  
Amannda Oliveira Rodrigues ◽  
Maria Fernanda Miguens Castellar Pinheiro ◽  
Rubens Antunes da Cruz Filho ◽  
Gilberto Peres Cardoso ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Cross Sectional Study ◽  
Diabetic Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
H2 Antagonists ◽  
H2 Antagonist ◽  
B12 Deficiency

ABSTRACT: CONTEXT AND OBJECTIVE: The prevalence of vitamin B12 deficiency varies from 5.8% to 30% among patients undergoing long-term treatment with metformin. Because of the paucity of data on Brazilian patients, this study aimed to determine the frequency of B12 deficiency and related factors among Brazilian patients with type 2 diabetes mellitus (T2DM) using metformin. DESIGN AND SETTING: Cross-sectional study at a public university hospital. METHODS: Patients with T2DM and a control group of non-diabetics were included. Serum B12 levels were measured and biochemical B12 deficiency was defined as serum levels < 180 pg/ml. Associations between B12 deficiency and age, duration of T2DM, duration of use and dosage of metformin, and use of proton pump inhibitors (PPIs) or histamine H2 antagonists were determined. RESULTS: 231 T2DM patients using metformin (T2DM-met) and 231 controls were included. No difference in the frequency of PPI or H2-antagonist use was seen between the groups. B12 deficiency was more frequent in the T2DM-met group (22.5% versus 7.4%) and this difference persisted after excluding PPI/H2-antagonist users (17.9% versus 5.6%). The factors that interfered with serum B12 levels were PPI/H2-antagonist use and duration of metformin use ≥ 10 years. Use of PPI/H2-antagonists was associated with B12 deficiency, with an odds ratio of 2.60 (95% confidence interval, 1.34-5.04). CONCLUSIONS: Among T2DM patients, treatment with metformin and concomitant use of PPI/H2-antagonists are associated with a higher chance of developing B12 deficiency than among non-diabetics.

scholarly journals Profiling immuno-metabolic mediators of vitamin B12 deficiency among metformin-treated type 2 diabetic patients in Ghana

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0249325
Author(s):  
Samuel Asamoah Sakyi ◽  
Edwin Ferguson Laing ◽  
Richard Mantey ◽  
Alexander Kwarteng ◽  
Eddie-Williams Owiredu ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Neuropathy ◽  
Vitamin B12 ◽  
Intrinsic Factor ◽  
Vitamin B12 Deficiency ◽  
Anthropometric Measurement ◽  
Diabetic Patients ◽  
Vitamin B ◽  
Tnf Α ◽  
B12 Deficiency

Background The association between prolong metformin usage and B12 deficiency has been documented. However, the prevalence estimates of metformin-induced vitamin B12 deficiency showed substantial disparity among studies due to varied study definitions of vitamin B12 deficiency. Metformin blocks the calcium dependent absorption of the vitamin B12-Intrinsic Factor complex at the terminal ileum. Lack of intrinsic factor due to the presence of auto-antibodies to parietal cells (IFA) could lead to vitamin B12 deficiency and subsequently cause peripheral neuropathy. We investigated the prevalence of vitamin B12 deficiency using more sensitive, combined markers of vitamin B12 status (4cB12) and the immuno-biochemical mediators of vitamin B12 deficiency. Methods In this observational study, 200 consecutive consenting metformin-treated T2DM patients, aged 35 and above, attending the diabetic clinic at KATH were recruited. Vitamin B12 deficiency was classified based on the Fedosov age-normalized wellness quotient. Anthropometric measurement was taken as well as blood samples for immunological and biochemical mediators. Peripheral neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Statistical analysis was performed using the R Language for Statistical Computing. Results Using the combined indicator (4cB12), the prevalence of metformin induced vitamin B12 deficiency was 40.5% whilst the prevalence of MNSI-Q and MNSI-PE diabetic neuropathy was 32.5% and 6.5% respectively. Participants with vitamin B12 deficiency had significantly higher levels of IFA, GPA, TNF-α, TC, LDL and albumin compared to those with normal vitamin B12 levels (p < 0.05). Correlation analysis revealed a statistically significant negative association between 4cB12 and the immunological markers [IFA (rs = -0.301, p<0.0001), GPA (rs = -0.244, p = 0.001), TNF-α (rs = -0.242, p = 0.001) and IL-6 (rs = -0.145, p = 0.041)]. Likewise, 4cB12 was negatively associated with TC (rs = -0.203, p = 0.004) and LDL (rs = -0.222, p = 0.002) but positively correlated with HDL (rs = 0.196, p = 0.005). Conclusion Vitamin B12 deficiency and diabetic neuropathy are very high among metformin-treated T2DM patients and it is associated with increased GPA, IFA, TNF-α and cardiometabolic risk factors (higher LDL and TC and lower HDL). Upon verification of these findings in a prospective case-control study, it may be beneficial to include periodic measurement of Vitamin B12 using the more sensitive combined indicators (4cB 12) in the management of patients with T2DM treated with metformin in Ghana.

scholarly journals Vitamin B12 Deficiency in Diabetic Patients on Metformin Therapy: A cross-sectional study from Oman

2020 ◽  
Vol 20 (1) ◽  
pp. 90
Author(s):  
Ahmed Al-Hamdi ◽  
Mohammed Al-Gahhafi ◽  
Shihab Al-Roshdi ◽  
Sanjay Jaju ◽  
Ali Al-Mamari ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Cross Sectional Study ◽  
Diabetic Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Metformin Therapy ◽  
B12 Deficiency

Objectives: This study aimed to determine the prevalence of vitamin B12 deficiency amongst diabetic patients on metformin therapy. Methods: This cross-sectional study was conducted at general clinics at the University Health Center and diabetes outpatient clinics at Sultan Qaboos University Hospital, Muscat, Oman, between January and December 2017. All Omani adults who were diagnosed with type 2 diabetes mellitus and took metformin were invited to participate in the study. The variables included in this study were age, gender, duration of diabetes, dose and duration of metformin therapy, haemoglobin and glycosylated haemoglobin level. Results: A total of 248 subjects were included (response rate = 95.4%) of which 26 (10.5%) were vitamin B12 deficient and 53 (21.4%) were borderline deficient. The mean daily dose of metformin was highest among vitamin B12 deficient group (1,981 ± 222 mg; P = 0.004). Conclusion: The prevalence of vitamin B12 deficiency is considerable among diabetic patients on metformin therapy. Further research is needed to confirm the need for routine screening and monitoring.Keywords: Type 2 Diabetes Mellitus; Prevalence; Metformin; Vitamin B12 Deficiency; Oman.

scholarly journals Vitamin B12 and Holotranscobalamin Levels in Diabetic Peripheral Neuropathy Patients

2016 ◽  
Vol 20 (1) ◽  
pp. 16-20
Author(s):  
Mohammed Noorjahan ◽  
Kandregula Madhavi ◽  
Chandran Priscilla ◽  
Shaik A Jabeen
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Neuropathy ◽  
Vitamin B12 ◽  
Diabetic Peripheral Neuropathy ◽  
Vitamin B12 Deficiency ◽  
Biologically Active ◽  
Significant Difference ◽  
B12 Deficiency ◽  
Vitamin B12 Supplementation

ABSTRACT Diabetic neuropathy is the most common and debilitating microvascular complication leading to nontraumatic amputations. Identifying the role of vitamin B12 in the etiology of neuropathy is crucial because simple vitamin B12 replacement may reverse neurologic symptoms if confirmed. Large proportion of vegetarians and patients on metformin have been associated with lowering of vitamin B12 levels. We have undertaken study on 60 vegetarian subjects between the age of 30 and 60 years, 20 healthy controls, 20 type 2 diabetes mellitus patients who were on metformin with peripheral neuropathy (DMWN), and 20 diabetics without peripheral neuropathy (DMWON). Vitamin B12, homocysteine, and folate levels were measured, and holotranscobalamin (holoTC) is also included, to improve the diagnosis of tissue vitamin B12 status, as holoTC is the biologically active fraction and more sensitive index of vitamin B12 status than total vitamin B12 itself. Complete history and clinical evaluation for neuropathy and electroneuromyography were recorded. Results In the DMWN group, vitamin B12 levels were significantly higher than in the DMWON group and controls [1013 (564-1501) pmol/l, 387 (245-731) pmol/l, and 305 (234-472) pmol/l respectively]. Similarly, serum holoTC was also found to be significantly higher in the DMWN [203.8 (129-300) pmol/l] group compared with the DMWON [94.4 (42.2-230.6) pmol/l] group and controls [74 (40-170) pmol/l]. Whereas mean levels of homocysteine and folate did not show any significant difference between groups, significant increase in fasting blood sugar and HbA1c was seen in the DMWN group compared with DMWON group and controls. Duration of diabetes is also significantly more in DMWN group compared with DMWON group. Conclusion We found that vitamin B12 and holoTC levels were high in patients with DMWN and DMWON groups compared with controls. Our study demonstrated that peripheral neuropathy was not associated with vitamin B12 deficiency in diabetics. These findings merit further research on a larger population to investigate into the cause of diabetic neuropathy, the factors involved, and benefit of vitamin B12 supplementation in these patients. Key messages Vitamin B12 status has no association with diabetic peripheral neuropathy. How to cite this article Noorjahan M, Madhavi K, Priscilla C, Jabeen SA. Vitamin B12 and Holotranscobalamin Levels in Diabetic Peripheral Neuropathy Patients. Indian J Med Biochem 2016;20(1):16-20.

scholarly journals The association of metformin use with vitamin B12 deficiency and peripheral neuropathy in Saudi individuals with type 2 diabetes mellitus

PLoS ONE ◽  
2018 ◽  
Vol 13 (10) ◽  
pp. e0204420 ◽  
Author(s):  
Turki J. Alharbi ◽  
Ayla M. Tourkmani ◽  
Osama Abdelhay ◽  
Hesham I. Alkhashan ◽  
Abdulrahman K. Al-Asmari ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Peripheral Neuropathy ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
B12 Deficiency
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