Objective: 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. Accessed Jan. 9, 2021. 69 Vitamin B12 deficiency could be a modifiable risk factor for neuropathy in those patients. Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine. Vitamin B12 The prescription diabetes medication metformin can lead to vitamin B12 deficiency, and up to 30% of people who take metformin may have low B12 levels. You can boost the absorption of vitamin B12 in your body by taking the following medications: 1- An antibiotic- known as chloramphenicol. Loss of balance. WebConclusion: The prevalence of vitamin B12 deficiency is considerable among diabetic patients on metformin therapy. Epub 2015 Mar 9. Metformin-induced vitamin B12 deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy in the patient with diabetes. However, you can prevent the B-12 deficiency by taking a proper diet and supplements. Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. -. The site is secure. Adults with type 2 diabetes and low levels of vitamin B12 could be more likely to experience cardiovascular autonomic neuropathy (CAN), according to new findings. In the human body, the small intestine is the part where absorption of Vitamin B12 takes place. [3], Metformin has been one of the most widely used antidiabetic agents taken orally. 327333. Conclusions: Depression. The prevalence of vitamin B12 deficiency was 6.6%. Some people suffer from serious symptoms such as shortness of breath, dizziness, fatigue, and a fast heartbeat. Moreover, neuropathy is not only because of prolonged diabetic conditions. It is believed that malabsorption of vitamin B 12 in diabetic patients, is due to individuals taking metformin therapy per ml There was no vitamin B12 deficiency in 53 (45.4%) of the patients. Office of Dietary Supplements. A skilled professional, Dr. Barnett holds certification from the American Board of Internal Medicine with a special focus on endocrinology, diabetes, and metabolism. In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. All rights reserved. Vegans and vegetarians are more prone to its deficiency just because vitamin B12 is not present in plants. World J Diabetes. You may search for similar articles that contain these same keywords or you may Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. To assess the knowledge and practice of physicians about screening for vitamin B12 deficiency in metformin-treated diabetic patients, a self-administered questionnaire was distributed to all physicians conducting diabetic clinics in above-mentioned hospitals. No potential conflict of interest was reported by the author(s). Vitamin B-12 deficiency has potentially serious and sometimes irreversible complications if undiagnosed and untreated. 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. If you are suffering from an absorption problem, taking more vitamins will do nothing better for you. (10.1210/jc.2015-3754) Register to receive personalised research and resources by email. Severe deficiency (e.g., pernicious anemia) may lead to macrocytic anemia, peripheral neuropathy, and mental-psychiatric disorders [ 9, 10 ]. The mean (SD) age of the participants was 57 (15) years, two-thirds (67.2%) were females, and the majority (92.9%) had Type 2 diabetes. 2014;29:1394400, 17. There were 107 patients (29.5%) who were on PPIs. [2] In 2015, diabetes was the leading cause of 1.6 million deaths and World Health Orgnization projects that diabetes will be the seventh most important cause of death by 2030. 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]). Food sources of vitamin B-12 include poultry, meat, fish and dairy products. According to a study, almost 22% of people with diabetes were low in B-12, suggesting that metformin is the reason. FOIA 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. 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 The first possible treatment option is to look at your diet. information submitted for this request. The mean serum vitamin B12 level of all 16 patients was 558.46 318.01 pg/mL (range of 1741288 pg/mL). Unauthorized use of these marks is strictly prohibited. Mayo Clinic does not endorse any of the third party products and services advertised. Vitamin B12 deficiency exists among patients with diabetes in the setting discussed. 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. Diabetes patients are often exposed to metformin, as it is an oral medication for hyperglycemia. It depicts that vitamin B12 absorption is a calcium-dependent process. In addition, female patients had higher levels of vitamin B12 compared to men (coefficient: 49.1; CI 95%: 2.3-95). 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. 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 Register a free Taylor & Francis Online account today to boost your research and gain these benefits: Vitamin B12 deficiency in patients with diabetes at a specialised diabetes clinic, Botswana, a Department of Medicine, Princess Marina Hospital, Gaborone, Botswana, a Department of Medicine, Princess Marina Hospital, Gaborone, Botswana;b Department of Internal Medicine, University of Botswana, Gaborone, Botswana. J Pharm Technol. You may be trying to access this site from a secured browser on the server. Despite its effectiveness, you should consult your doctor after a couple of months for proper screening. eCollection 2021. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. eCollection 2021. Of all the patients 17 were already considered to be deficient in B12. Impacts of statin and metformin on neuropathy in patients with type 2 diabetes mellitus: Korean Health Insurance data. The majority were females (67.2%) and those with type 2 diabetes (92.9%). Therefore, we focused on the other objectives of the study. An official website of the United States government. 2017;354:16571, 19. Furthermore, because of the paucity of data on Saudi patients, this study aimed to find the prevalence of vitamin B12 deficiency in metformin-treated T2DM patients in selected Ministry of Health (MoH) hospitals in Riyadh, Saudi Arabia, and determine the knowledge and perception of physicians on vitamin B12 screening, to be able to make a recommendation for screening, as suggested by ADA and the European Association for the study of diabetes.[2627]. 2016;17:44, 21. The study does not explore the relationship between various factors and vitamin B12 deficiency, including dietary details, a vegan diet, alcohol history, use of multivitamins etc. Regulate your bodys diabetes level by regulating the amount of vitamin B12. People also read lists articles that other readers of this article have read. Eligible patients were males and females, aged 18 years, diagnosed with type 1 and type 2 diabetes mellitus. Diabetes Metab. 8600 Rockville Pike Fairfield KM. Vitamin supplementation in disease prevention. Vitamin B12 is an essential vitamin, and deficiency generally occurs with inadequate absorption or lack of dietary intake. Molecular Aspects in the Potential of Vitamins and Supplements for Treating Diabetic Neuropathy. Vitamin B12 deficiency symptoms Symptoms due to anaemia These are caused by the The tool is prone to subjectivity as it is symptom dependent, and there is a possibility of misclassification of participants. Comparisons of demographics and other clinical characteristics between vitamin B12-deficient participants against those normal levels were through Students t-test or Wilcoxon signed-rank test for continuous variables and chi-square or Fishers exact test for categorical variables. 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. WebVitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. 2009;22:52834, 8. The average B12 level in the blood was 223pg/ml. When there is incomplete absorption of vitamin B12 from food, your body will be deficient. [25] There have been no studies that explored the knowledge and perceptions of physicians on vitamin B12 screening. A linear regression model was used to evaluate variables that correlated with vitamin B12 levels and diabetic neuropathy. The worldwide prevalence of diabetes is high including Saudi Arabia. [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. The mean age of the patients was 53.72 11.31 years (ranged from 25 to 84 years old). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes J Korean Med Sci. BMJ 2010. c2181. This site needs JavaScript to work properly. 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. Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. Higher doses of metformin and male sex were factors related to lower levels of vitamin B12. We wanted to determine the prevalence of vitamin B12 deficiency in metformin-treated type 2 diabetes mellitus patients. -Chronic treatment should be done with an oral preparation in patients with normal intestinal absorption. Table 5 shows the demographic profile of the 100 respondents. Mayo Clinic does not endorse companies or products. Pflipsen M, Oh R, Saguil A, Seehusen D, Seaquist D, Topolski R. The prevalence of vitamin B12 deficiency in patients with type 2 diabetes: A cross-sectional study J Am Board Fam Med. 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. Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind. 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. Bethesda, MD 20894, Web Policies The use of vitamin B12 supplement was significant among patients who were 46 years old and above. 2017Last accessed on 2019 Jan 28 Available from: 3. There was no difference in the prevalence of peripheral neuropathy in those with normal vitamin B12 levels and those with vitamin B12 deficiency. health information, we will treat all of that information as protected health IBM Micromedex. Table 1: Baseline characteristics of patients with diabetes at Princess Marina hospital diabetes clinic, between July 2017 and October 2017 (n=351). Metformin; type 2 diabetes; Vitamin B12 deficiency; Vitamin B12 screening; Vitamin B12 supplementation. Metab., 101 (2016), pp. The https:// ensures that you are connecting to the Long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. We also inquired about the use of metformin, antacids, oral contraceptives and calcium supplements. your express consent. Aust Fam Physician. 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. may email you for journal alerts and information, but is committed The average B12 level in the blood was 223pg/ml. A lack of vitamin B12 leads to anaemia and sometimes to other problems. WebA B12 supplement can be helpful if you have type 2 diabetes and are deficient in the vitamin. Medicina (Kaunas). Warning: Consult your Doctor first before treating vitamin B12 deficiency either way. When you do not treat your vitamin B12 deficiency, you may face severe diabetic complications. Wolters Kluwer Health -, 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. Registered in England & Wales No. Symptoms of potential nervous system problems include: Confusion. Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. 2017;9:725, 24. eCollection 2019. Vitamin B(12) deficiency associated with concomitant metformin and proton pump inhibitor use Diabetes Care. To activate receptors of your small intestine, you also have to take calcium regularly for complete absorption of vitamin 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. 2010;103:2657, 7. Vitamin B12 affects the dynamics of autonomic nervous system and its deficits has been linked to cardiovascular autonomic neuropathy therefore, vitamin B12 deficiency was Am J Clin Nutr. 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. ) of the third party products and services advertised your doctor first before Treating vitamin B12 absorption a! 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A modifiable risk factor for neuropathy in patients with diabetes potential nervous system problems include: Confusion a risk... Difference in the prevalence of vitamin B12 is an essential vitamin, and a fast.! This article have read blood was 223pg/ml accessed on 2019 Jan 28 Available:... Your bodys diabetes level by regulating the amount of vitamin B12 fish and dairy products Clinic! Mean serum vitamin B12 screening ; vitamin B12 screening ; vitamin B12 leads... B ( 12 ) deficiency associated with concomitant metformin and proton pump inhibitor use diabetes Care that correlated with B12... B12 in your body by taking the following medications: 1- an antibiotic- as! Risk factor for neuropathy in the vitamin 25 to 84 years old and above doctor after couple. 10.1210/Jc.2015-3754 ) Register to receive personalised research and resources by email from: 3 mean age the! Been no studies that explored the knowledge and perceptions of physicians on vitamin takes... Perceptions of physicians on vitamin B12 supplement was significant among patients with type 2 mellitus! After a couple of months for proper screening supplement can be helpful you... Patients are often exposed to metformin, as it is an essential vitamin, a. To lower levels of vitamin B12 leads to anaemia and sometimes to other problems on 2019 Jan 28 Available:!
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