The median (IQR) duration since the diagnosis of diabetes was 6 (212) years, and 89.5% of participants were on metformin. Vitamin B-12 supplements also are recommended for women who are pregnant or breastfeeding exclusively and follow vegetarian or vegan diets. 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. While the recommended daily amount of vitamin B-12 for adults is 2.4 micrograms, higher doses have been found to be safe. Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy South Med J. This review article offers a current perspective on the physiological roles of vitamin B12, proposed pathophysiological mechanisms of vitamin B12 deficiency, screening for vitamin B12 deficiency and vitamin B12 supplementation among patients with diabetes mellitus. Two common types of GERD medicines have been associated with B-12 deficiency to varying degrees: H-2-receptor blockers. Never take a supplement or injection at your own decision. Proactively addressing the risk of developing low vitamin B 12 levels in this patient population not only reduces potential physical and mental sequelae but also lessens the financial burden of disease, appointments, testing, loss of Folic acid with or without vitamin B12 for cognition and dementia. suggested that the mechanism for this vitamin B12 deficiency is caused by the slowed intestinal transit time among diabetics causing bacterial overgrowth and eventually B12 malabsorption. 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. Careers. Allen LH. -. In those with diabetic neuropathy, altered (low and borderline) vitamin B12 level was 64% (95% CI: 47-78%) compared to 17% (95% CI: 10-26%) in patients without diabetic neuropathy (coefficient: -110.8; CI 95%: -165.8, -59.7). Vitamin B12 deficiency was defined as serum levels less than 148 pmol/L or 200 pg/mL.[24]. Taking omeprazole (Prilosec), lansoprazole (Prevacid) or 2013;71:38690, 12. Well, you can fulfill vitamin B12 intake through energy bars and breakfasts having fortified B12. 2016;59:42635, 31. Methods: 2022;74(7):2373-2383. doi: 10.1080/01635581.2021.2007271. Treatment Of B12 Deficiency In Diabetes Patients. 2- Is Vitamin B complex healthy for diabetic patients? Accessibility Vitamin B12 deficiency is common with increased age, long duration of metformin use and acid blockers. Cureus. Disclaimer. Unauthorized use of these marks is strictly prohibited. Means RT Jr, et al. Diabetes mellitus (DM) is a chronic metabolic disease with increasing prevalence worldwide. Through this, not only your vitamin B12 level can be examined, but also your folate level does. This content does not have an Arabic version. Encephale. Although it is validated for evaluating peripheral neuropathy, it is prone to subjectivity as it is symptom dependent.Citation14 Modified Toronto Clinical Neuropathy Score (m-TCNS) with better reliability is an alternative in subsequent studies.Citation55. Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml (56.2%); 23 diabetic patients did not get metformin and only 4 had vitamin B12 level < 240 pg/ml (17.4%) (P = 0.014). Clipboard, Search History, and several other advanced features are temporarily unavailable. Lets read how type 1 and 2 diabetes affect the level of Vitamin B12 in your body. Vitamin B12 affects the dynamics of autonomic nervous system and its deficits has been linked to cardiovascular autonomic neuropathy therefore, vitamin B12 deficiency was eCollection 2022 Aug. Farland MZ, McPheeters CM, Renwick RC, Barlow PB, Williams JD, Keeble DS, Franks AS. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. One standard first-line treatment for diabetes is metformin, which was reported to increase the risk for vitamin B12 deficiency. 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. 2023 ALL RIGHTS RESERVED DISCLAIMER: RESULTS MAY VARY FROM PERSON TO PERSON, Healthy diabetes meal plan crafted just for YOU, Personalized workouts with no equipment needed, Track your progress with smart tracking tools. However, it may lower vitamin B12 concentrations, which could have hematological or neurological implications. There are some limitations of this current study. It is because diabetics mostly take metformin, which is a well-known treatment of Type-2 diabetes. PMC Metformin Use Increases Vitamin B12 Deficiency in Patients With Diabetes The dose and duration of metformin is linked with vitamin B12 deficiency, which have implications for planning screening or prevention strategies in patients with diabetes. Vitamin B12 deficiency is then easily missed. WebVitamin B-12 deficiency anemia is a condition in which your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B-12. [25] There have been no studies that explored the knowledge and perceptions of physicians on vitamin B12 screening. Similar findings have been previously reported in different settings.Citation20,Citation4749 In the current study, NTSS-6 was used to assess neuropathy. Hunt A, Harrington D, Robinson S. Vitamin B12 deficiency Bmj. There were 107 patients (29.5%) who were on PPIs. Because there is a possibility that taking vitamin B12 pills will not be the right choice for you. 2009;22:52834, 8. [30] Metformin causes gastrointestinal disturbances when started at a higher dose and with long-term use through competitive inhibition or inactivation of Cb1 absorption, alterations in the intrinsic factor levels, interactions with the cubulin endocytic receptor, and antagonism of the calcium-dependent ileal membrane. A large percentage of physicians are not aware of the current recommendations of the ADA regarding vitamin B12 supplementation and screening. WebVitamin B12 deficiency is related to a number of comorbidities, such as peripheral neuropathy and megaloblastic anemia. [1], The number of persons with diabetes has risen from 108 million in 1980 to 422 million in 2014. Vitamin B(12) deficiency associated with concomitant metformin and proton pump inhibitor use Diabetes Care. Viollet B, Guigas B, Garcia N, Leclerc J, Foretz M, Andreelli F. Cellular and molecular mechanisms of metformin: An overview Clin Sci. 2006;35:2001, 6. There was no vitamin B12 deficiency in 53 (45.4%) of the patients. The mean HbA1c for all patients was 8.45 2.01% (range: 4.2316.0). Metab., 101 (2016), pp. Of all the patients 17 were already considered to be deficient in B12. 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. 2009;32:193203, 28. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. Therefore, we focused on the other objectives of the study. However, people who follow a vegetarian or vegan diet might be prone to deficiency because plant foods don't contain vitamin B-12. Its all about the vitamin B12 that gets absorbed into our blood from the small intestine. Low vitamin B12 levels were found in 7.3% (95% CI: 4.0-12%) of patients. 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. When vitamin B12 does not reach the small intestine, it will not be absorbed properly, causing vitamin B12 deficiency. All data were entered and analysed using SPSS Statistics for Windows, Version 23.0 (IBM SPSS Statistics for Windows, Version 23.0 [IBM Corp, Armonk, NY, USA]). The first possible treatment option is to look at your diet. WHO Media Centre. 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 Under normal routine, stomach cells create this protein. Depression. While in anemia, the number of healthy red blood cells to carry out oxygen depletes. No matter whether you have diabetes or not, never ignore peripheral and diabetic neuropathy. Also, a single-centre nature of the study limits the generalisation of the study findings. 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. However, diabetes type 2 can regulate glycemic amounts in blood in collaboration with the therapeutic effect of B12. Experiencing nausea, vomiting or diarrhea. Moreover, low levels of B12 can cause homocysteine (high levels of amino acid), leading to stroke and cardiovascular disorders. Another limitation is that we could have collected/determined the homocysteine levels, holotranscobalamin, methylmalonic acid, and red blood cell B12 of the patients, which could have helped us determine if there is true tissue deficiency of vitamin B12, that will help us determine vitamin B12 deficiency when no laboratory determination of serum vitamin B12 level is available. Metformin associated B12 deficiency J Assoc Physicians India. Did you know that with a free Taylor & Francis Online account you can gain access to the following benefits? Sample size was calculated using the formula (N = 4 pq/d2, where N is the sample size, P is the expected population, q = 1-p, and d as the precision. Instead of lowering blood glucose levels, the level of vitamin B12 gets lowered itself in diabetic patients. Vitamin B12 is an essential micronutrient required for optimal hemopoetic, neuro-cognitive and cardiovascular function. Forty-four (44.0%) of the respondents know the current recommendation of ADA on vitamin B12 screening and supplementation among diabetic patients, 39 (39.0%) do not know about the current recommendation, whereas 17 (17.0%) have no idea about the recommendation. At the same time, its better to use natural dietary fibers like foods rich in vitamin B12. MeSH WebFrequent doses of metformin can result in vitamin b12 deficiency. Owhin SO, Adaja TM, Fasipe OJ, Akhideno PE, Kalejaiye OO, Kehinde MO. Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml Even though it has known efficacy and favorable safety profile, there are reported side effects such as vitamin B12 malabsorption. Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind. Diabetes patients are often exposed to metformin, as it is an oral medication for hyperglycemia. 3099067 Estimation of Serum Vitamin B12 Levels Among the Elderly Population of Wardha City: A Cross-Sectional Study. A hospital-based screening study using a panel of serum biomarkers, Seroprevalence of Helicobacter pylori and length of stay in a nursing home, Independent effect of vitamin B12 deficiency on hematological status in older Chinese vegetarian women, Prevalence and possible factors associated with anaemia, and vitamin B 12 and folate deficiencies in women of reproductive age in Pakistan: analysis of national-level secondary survey data, Evaluation of current criteria used to measure vitamin B12 levels, Cobalamin status and its relation with depression, cognition and neuropathy in patients with type 2 diabetes mellitus using metformin, Serum vitamin B12 levels in type 2 diabetes patients on metformin compared to those never on metformin: A cross-sectional study, Investigation of the vitamin B12 deficiency with peripheral neuropathy in patients with type 2 diabetes mellitus treated using metformin, Association of metformin, elevated homocysteine, and methylmalonic acid levels and clinically worsened diabetic peripheral neuropathy, The role of metformin on vitamin B12 deficiency: a meta-analysis review, Vitamin B12 deficiency and the lack of its consequences in type 2 diabetes patients using metformin, Neurologic aspects of cobalamin deficiency, Biomarkers of vitamin B12 status in NHANES: a roundtable summary, Reliability and validity of the modified Toronto clinical neuropathy score in diabetic sensorimotor polyneuropathy, Journal of Endocrinology, Metabolism and Diabetes of South Africa. 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