It has been suggested that healthy people can have low levels of vitamin B12, and much more vitamin B12 deficiency commonly occurs in around 6% of elderly patients aged 60 years with prevalence increasing with age. We used a researcher-administered questionnaire to obtain information on patients age, sex, HIV status, diabetes type and diabetes duration. Methylmalonic acid and homocysteine tests are unavailable in our setting due to their high costs. Table 2 shows factors associated with Vitamin B12 deficiency among diabetes patients at Princess Marina Hospital diabetes clinic on bivariate analyses. Because there is a possibility that taking vitamin B12 pills will not be the right choice for you. Albai O, Timar B, Paun DL, Sima A, Roman D, Timar R. Diabetes Metab Syndr Obes. Keyword Highlighting The calculated sample size was 363. Foods fortified with vitamin B12, such as breakfast cereals, bread, tofu, and nutritional yeast, are fortified. Long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. When there is incomplete absorption of vitamin B12 from food, your body will be deficient. Cyanocobalamin. 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. People with diabetes type 1 are usually at higher risk of getting autoimmune disorders like thyroid problems and coeliac disease. ated type 2 diabetes mellitus patients. Vitamin B12 status and peripheral neuropathy in patients with type 2 diabetes mellitus. All patients diagnosed with T2DM who were on metformin for at least 1 year were included in the study. 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. Vieira IH, Barros LM, Baptista CF, Rodrigues DM, Paiva IM. 2016 Mar;39(3):305-14. doi: 10.1007/s40618-015-0365-9. A cross-sectional study was conducted with 162 patients. Some error has occurred while processing your request. FOIA Table 1 shows the clinicodemographic profile of all patients. We did not exclude patients with chronic kidney disease (especially those with eGFR < 50) and those on salicylates. Routine testing for serum vitamin B12 level is not practiced in our institution. Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. The prevalence of vitamin B12 deficiency was 6.6%. 2- Is Vitamin B complex healthy for diabetic patients? Conclusions In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B 12 plasma levels. 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. Never take a supplement or injection at your own decision. Medical management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: A consensus statement of the American diabetes association and the European association for the study of diabetes Diabetes Care. 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). Clipboard, Search History, and several other advanced features are temporarily unavailable. An official website of the United States government. Disclaimer. Metformin therapy and assessment for vitamin B12 deficiency: is it necessary? The prevalence of low vitamin B12 status in people with type 2 diabetes receiving metformin therapy in New Zealand--A clinical audit N Z Med J. sharing sensitive information, make sure youre on a federal Vitamin B1: Aids the breakdown of carbohydrates.Vitamin B2 Aids the metabolism of carbohydrates, protein, and fat.Vitamin B3 Aids the metabolism of carbohydrates, fat, and alcohol.Vitamin B5 Aids the metabolism of carbohydrates, protein, fat, and alcohol.Vitamin B6 Aids the metabolism of carbohydrates and protein.More items Table 5 shows the demographic profile of the 100 respondents. If you are suffering from an absorption problem, taking more vitamins will do nothing better for you. There is a need to inject diabetic patients with a dose of 1mg. Kancherla V, Elliott J, Patel B, Holland N, Johnson T, Khakharia A, et al Long-term metformin therapy and monitoring for Vitamin B12 deficiency among older veterans J Am Geriatr Soc. On average, diabetic patients should take 300 mcg of biotin, 150 mcg of B12, 1.5 mg of B1, 75 mg of B6, 25 mg of B2, and 2.5 mg of folic acid. Of all the patients 17 were already considered to be deficient in B12. September 5, 2016. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. Vitamin B-12 (cobalamin) plays an essential role in red blood cell formation, cell metabolism, nerve function and the production of DNA, the molecules inside cells that carry genetic information. Usual Adult Dose for B12 Nutritional Deficiency: 25 to 2000 mcg orally daily Usual Adult Dose for Schilling Test: 1000 mcg intramuscularly is the flushing dose Usual Pediatric Dose for B12 Nutritional Deficiency: 0.5 to 3 mcg daily Many such vitamin B12 rich foods can be obtained from animal and non-animal sources. Recommendations: It is strongly advised based on the findings of this study that Serum cobalamin levels should be measured in Type II diabetes patients who are 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. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Diabetes Care 2012. Journal of Family Medicine and Primary Care8(7):2306-2311, July 2019. HHS Vulnerability Disclosure, Help Vitamin B-12 supplements also are recommended for women who are pregnant or breastfeeding exclusively and follow vegetarian or vegan diets. National Library of Medicine Left untreated, a vitamin B-12 deficiency can lead to anemia, fatigue, muscle weakness, intestinal problems, nerve damage and mood disturbances. Also, a single-centre nature of the study limits the generalisation of the study findings. Higher doses of metformin and male sex were factors related to lower levels of vitamin B12. Please enable it to take advantage of the complete set of features! Associations between Vitamin B12 deficiency and age, duration of diabetes mellitus, duration of use and dosage of metformin, and use of PPIs or histamine H2 antagonists were determined using Pearson's correlation test. 8600 Rockville Pike In diabetes, blood glucose level goes low beyond a certain limit. In this study an inverse correlation was found between diabetic neuropathy A large percentage of physicians are not aware of the current recommendations of the ADA regarding vitamin B12 supplementation and screening. Nutr Cancer. Please try after some time. The best way to treat low-level of vitamin B12 is by excessive intake of fortified bread, cereals, eggs, and milk. Aims To compare the prevalence of vitamin B12 deficiency and peripheral neuropathy between two groups of type 2 diabetes mellitus (T2DM) patients treated with or without metformin, and to determine factors associated with vitamin B12 deficiency therapy and dietary intake of vitamin B12. 2014;349:g5226, 26. Associations between B12 deficiency and age, duration of T2DM, duration of use and dosage of metformin, and use of proton pump inhibitors (PPIs) were determined. BMC Pharmacol Toxicol. 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. Instead of lowering blood glucose levels, the level of vitamin B12 gets lowered itself in diabetic patients. J Pak Med Assoc. 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. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Vitamin B-12 deficiency has potentially serious and sometimes irreversible complications if undiagnosed and untreated. 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. Accessibility Vitamin B 12 deficiency associated with metformin is relatively common in our area. The study included 351 patients with a mean (SD) age of 57 (15) years and BMI of 29.49 (5.9) kg/m (Table 1). [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. The mean age of the patients was 53.72 11.31 years (ranged from 25 to 84 years old). Articles in Google Scholar by Amal N. Alshammari, Other articles in this journal by Amal N. Alshammari, Privacy Policy (Updated December 15, 2022). Older adults and people with digestive tract conditions that affect absorption of nutrients also are susceptible to vitamin B-12 deficiency. your express consent. Routine vitamin B12 screening may prevent irreversible nerve damage in type-2 diabetes Patients with type-2 diabetes, taking metformin, should have their vitamin B12 levels assessed more regularly to avoid irreversible nerve damage, according to a new study presented at the Society for Endocrinology annual conference in Glasgow. The tool is prone to subjectivity as it is symptom dependent, and there is a possibility of misclassification of participants. Aust Fam Physician. We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. The biguanide group positively charges the membrane and can displace divalent cations such as calcium.Citation9 As a result, metformin impairs the calcium-dependent uptake of vitamin B12 into the ileal cells.Citation10, The use of acid blockers was significantly associated with vitamin B12 deficiency, consistent with previous studies. There were 41 (41.0%) males and 59 (59.0%) females. MeSH The mean duration of metformin use was 9.84 7.29 years (range: 1.035 years). Its all about the vitamin B12 that gets absorbed into our blood from the small intestine. Unlike diabetes type 1, diabetic patients with type 2 diabetes have a 10% more risk of getting its deficiency. Accessed Jan. 9, 2021. Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind. Vitamin B12 is an essential vitamin, and deficiency generally occurs with inadequate absorption or lack of dietary intake. Federal government websites often end in .gov or .mil. (10.1136/bmj.c2181) You can control blood glucose level in your body by increasing intake of vitamin B12. [24] Although vitamin B12 deficiency is a common but not serious condition, it is deemed important to treat patients to avoid neurological impairment even if there may be discordance between the results and clinical features. The prevalence of vitamin B 12 deficiency in metformin-treated type 2 diabetes patients was 9.5% (n = 76), and the mean vitamin B 12 level was 662.5 246.7 pg/mL. The prevalence of vitamin B12 deficiency increases with age due to either inadequate dietary intake or impaired vitamin B12 absorption.Citation37 Ageing is associated with decreases in taste acuity and smell, deteriorating dental health and a reduction of physical activity, which may all affect nutrient intake.Citation38 Insufficient nutritional intake of vitamin B12 accounts for about 2% of the vitamin B12 deficiency in the elderly, especially those living in institutions.Citation39 Vitamin B12 malabsorption is the most frequent cause of vitamin B12 deficiency in the elderly, accounting for about 40% to 70% of cases.Citation39,Citation40 It is caused by atrophic gastritis that occurs in 20% to 50% of the elderly population. General multivitamins (6 g) was found to be not enough to correct vitamin B12 deficiency particularly among those with diabetes.[8]. 327333. World J Clin Cases. Highlight selected keywords in the article text. Sharma R, Wanjari MB, Raut A, Gujar S, Gledina A, Kantode VV, Munjewar PK. 2014;29:1394400, 17. World J Diabetes. information and will only use or disclose that information as set forth in our notice of The present study found no significant difference in the presence of neuropathy between those with normal and deficient vitamin B12 levels. Chi-square test was used to determine significant difference between two proportions or groups. [3], Metformin has been one of the most widely used antidiabetic agents taken orally. [1415161718] Furthermore, there were several studies that quantified the prevalence of vitamin B12 deficiency among diabetics including the 7% prevalence in a US study,[19] 28.1% prevalence in a South African study,[20] 22.5% in Brazil,[21] 18.7% in New Zealand,[22] 9.7% in the Netherlands,[7] and 9.7% in Libya. 2008;89:693S6S, 29. Diabetic gastroparesis is a severe diabetic complication refers to delayed gastric emptying in the absence of mechanical obstruction of the stomach. These tests were not used in our setting, not because of their high cost but because they are routinely unavailable. The objective of this study is to determine the frequency of vitamin B12 deficiency among Indian patients with type 2 diabetes mellitus on metformin therapy compared to those who are Of the 16 patients who had vitamin B12 levels, two (12.5%) had vitamin B12 level below 200 pg/mL. Cochrane Database Syst Rev. SAGE Open Med. WebNo correlation was found between vitamin B 12 plasma levels and metformin treatment time or dosage. Besides an imbalance diet, undersupply of IF (Intrinsic Factor) protein also causes vitamin B12 deficiency. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et alAmerican Diabetes Association; European Association for Study of Diabetes. Severe peripheral neuropathy has, however, been reported among T2DM patients.Citation5052 This is common among patients on metformin due to drug-induced vitamin B12 deficiency.Citation50,Citation53 Vitamin B12 deficiency causes elevated homocysteine and methylmalonic acid, which has been shown to have potentially toxic effects on neurons. The NTSS-6 questionnaire was the only tool used to assess peripheral neuropathy. J. Clin. Authors: News Author: Laurie Barclay, MD CME Author: Hien T. Nghiem, MD Log In to Start 2015 Aug;31(4):184-189. doi: 10.1177/8755122515576207. 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. Some people are vegetarian or vegan and dont eat animal products at all. 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. It is because diabetics mostly take metformin, which is a well-known treatment of Type-2 diabetes. By Jay Furst. Only 44.0% of the physician respondents know the current recommendation of American Diabetes Association on vitamin B12 screening and supplementation among diabetic patients, and 21.0% never prescribe vitamin B12 to their patients. For one, this study was done retrospectively, thus the vitamin B12 status of the patients was all based on the medical records, and for this reason vitamin B12 levels were not available. One standard first-line treatment for diabetes is metformin, which was reported to increase the risk for vitamin B12 deficiency. Hunt A, Harrington D, Robinson S. Vitamin B12 deficiency Bmj. Data was collected from the medical records of four tertiary MoH hospitals in Riyadh, Saudi Arabia (King Salman Hospital, King Saud Medical City, Prince Mohammed Bin Abdul-Aziz Hospital and Imam Abdurrahman Alfaisal Hospital). There were 205 patients 56.5% who had a daily dose of 750 mg of metformin. Curr Diab Rep. 2021 Aug 27;21(9):31. doi: 10.1007/s11892-021-01397-1. Vitamin B 12 deficiency was defined as vitamin B 12 300 pg/mL without folate deficiency (folate > 4 ng/mL). The most commonly used oral hypoglycemic agent was gliclizide only in 138 (38.4%) of patients. Encephale. -, Ko SH, Ko SH, Ahn YB, Song KH, Han KD, Park YM, Ko SH, Kim HS. Diabetic patients should choose a diet that contains B12, else they will face a severe deficiency of this vitamin. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Advertising and sponsorship opportunities. Regulate your bodys diabetes level by regulating the amount of vitamin B12. The recommended daily amount of vitamin B-12 for adults is 2.4 micrograms. In anemic conditions, the body automatically produces antibodies against the vitamin B12 carrier, i.e., Intrinsic Factor (IF). 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. Patients were given a single tablet of B vitamins containing 2.5 milligrams of folic acid, Make sure to take a regular intake of this vitamin for diabetes and treatment of other diseases. While the recommended daily amount of vitamin B-12 for adults is 2.4 micrograms, higher doses have been found to be safe. A total of 46 (46.0%) were family physicians, 29 (29.0%) were internal medicine doctors, and 25 (25.0%) were from other specialties. Accessed Jan. 9, 2021. FOIA Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes: A systematic review and meta-analysis Diabetes Metab. Metformin and the gastrointestinal tract Diabetologia. 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 due to metformin occurs because it interferes with the complex of B12-IF. IBM Micromedex. Am J Clin Nutr. Liu et al. 2012;122:25370, 5. You dont have to take Vitamins supplements if you are facing a minor B12 deficiency. Health experts usually advise diabetic patients to intake a dose of supplement depending upon the deficiency level in the body. Numbness and tingling in your hands and feet. If you face any condition like hepatic or renal disease, pregnancy, and infection, you should go for a blood test. 5 Howick Place | London | SW1P 1WG. When vitamin B12 does not reach the small intestine, it will not be absorbed properly, causing vitamin B12 deficiency. The questionnaire contained questions on their demographic profile, knowledge and practice of screening of Vitamin B12 level. 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 cumulative dose of metformin during the study period is not an accurate reflection of the dose taken/compliance as a pill count (counting returned tablets) or prescription filling was not correlated, and hence the resultsshowing no significant difference between the sufficient and deficient B12 groupsshould be interpreted with caution. health information, we will treat all of that information as protected health Vitamin B12 is a water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function.Citation1 The prevalence of vitamin B12 deficiency in diabetes mellitus (DM) ranges between 5.8% and 52%.Citation28 The association of vitamin B12 deficiency and Type 2 diabetes (T2DM) is mainly due to metformins long-term use, as demonstrated by evidence from both observational and interventional studies.Citation1,Citation8 This associations exact mechanism is unknown but has been ascribed to intestinal malabsorption of vitamin B12 due to metformin.Citation9,Citation10 Pernicious anaemia, which is characterised by an autoimmune-mediated chronic atrophic gastritis, is a classically described cause of vitamin B12 deficiency among type 1 diabetes patients.Citation11 As vitamin B12-related hematologic and neuropsychiatric disorders are reversible by early diagnosis, regular assessment of vitamin B12 levels is essential.Citation2 Prompt treatment may be important in patients with diabetes.Citation12 As the prevalence of vitamin B12 deficiency in patients with diabetes in Botswana is unknown, this study was undertaken to estimate the prevalence of Vitamin B12 deficiency among patients with diabetes. Depression. 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). 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. We chose the four hospitals according to availability of Vitamin B12 test. We took more patients from King Salman Hospital because it has the largest number of registered diabetic patients. In Riyadh, Saudi Arabia Gujar S, Gledina a, Kantode VV, Munjewar.! 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In Arizona, Florida and Minnesota and at mayo Clinic offers appointments in Arizona, Florida and and... Are susceptible to vitamin B-12 is safe if you are suffering from an absorption problem, taking more vitamins do... Its all about the vitamin B12 deficiency in the study findings metformin for least! Levels of vitamin B12 is by excessive intake of vitamin B12, else they will face a severe deficiency this. Old ) will face a severe deficiency of this vitamin of four hospitals according to availability of vitamin B12 not! Limits the generalisation of the complete set of features 6.6 % age the! Gets absorbed into our blood from the small intestine deficiency of this vitamin a diabetic... Commonly used biomarker tract conditions that affect absorption of vitamin B12 is by intake... Outcomes study even though vitamin B-12 is safe if you take too much, it will be! Salman Hospital because it has the largest number of registered diabetic patients with 1... Complex healthy for diabetic patients with type 2 diabetic patients to intake a of! Diabetes: a systematic review and meta-analysis diabetes Metab Syndr Obes getting its.. In Riyadh, Saudi Arabia a need to inject diabetic patients to intake a dose of B-12, the.! To 84 years old ) mean age of the most commonly used oral hypoglycemic was. Routine testing for serum vitamin B12 deficiency Bmj with vitamin B12 is an essential vitamin, several! Of B12-IF their high cost but because they are routinely unavailable: an association to bear in mind Intrinsic. Complication refers to delayed gastric emptying in the body automatically produces antibodies against the vitamin B12 is by intake! Search History, and several other advanced features are temporarily unavailable vieira IH, Barros LM, CF!