Prevalence of vitamin B12 deficiency in type 2 diabetes mellitus patients on metformin therapy in a tertiary care hospital

Authors

  • Gomathi A. Department of Pharmacology, Government Vellore Medical College, Vellore, Tamil Nadu, India
  • Keerthiga K. Department of Pharmacology, Government Vellore Medical College, Vellore, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20205128

Keywords:

Metformin, B12 deficiency, Diabetes mellitus

Abstract

Background: The objective of the study was to estimate the prevalence of vitamin B12 deficiency and presence of peripheral neuropathy in type 2 diabetes patients on metformin treatment.

Methods: This cross-sectional study was carried out in Department of Biochemistry and Medicine in a tertiary care teaching hospital in south India. Type 2 diabetes mellitus patients diagnosed based on World Health Organization (WHO) criteria treated with metformin for more than 6 months were included in the study. B12 levels were estimated and DNS scoring, vibration perception test and 10 gm Semmes-Weinstein monofilament test done.

Results: A total of 55 participants were identified. Most of them were on 1500 mg of metformin once a day in divided dose. In this study maximum number of participants are in the age group of 50-70 years. Peripheral neuropathy is seen in 43.9% of persons with normal B12 levels and 28.5% of persons with low B12 levels. A Chi square test showed a chi square statistic value of 1.8221 with a p value of 0.312 which is not significant. Univariate analysis showed vitamin B12 deficient patients are of significantly higher age (63 years versus 57 years p=0.01) and with higher duration of treatment (9 years versus 6 years p=0.01).

Conclusions: Prolonged metformin therapy is associated with deficiency of vitamin B12. The prevalence of B12 deficiency among diabetic patients on metformin was found to be 25.45%. Routine B12 estimation and correction of low B12 levels will be beneficial to these patients. Earlier initiation of B12 in patients on metformin may prevent the onset of neurological damage.

References

Katzung, Trevor, Masters. Basic and Clinical Pharmacology. 12th edition. Mc-Graw Hill. 2010.

American Diabetes Association. Standards of medical care in diabetes: 2013. Diabetes Care. 2013;36:S11-66.

de Jager J, Kooy A, Lehert P, WulffeleMG, van der Kolk J, Bets D, et al. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B- 12 deficiency: randomised placebo controlled trial. BMJ. 2010;340:c2181.

Reinstatler L, Qi YP, Williamson RS, Garn JV, Oakley Jr GP. Association of biochemical B12 deficiency with metformin therapy and vitamin B12 supplements: the National Health and Nutrition Examination Survey, 1999–2006. Diabetes Care. 2012;35(2):327-33.

Hermann LS, Nilsson B, Wettre S. Vitamin B12 status of patients treated with metformin: a cross-sectional cohort study. Br J Diabetes Vasc Dis. 2004;4:401-4.

de Groot-Kamphuis DM, van Dijk PR, Groenier KH, Houweling ST, Bilo HJ, Kleefstra N. Vitamin B12 deficiency and the lack of its consequences in type 2 diabetes patients using metformin. Neth J Med. 2013;71(7):386-90.

Calvo Romero JM, Lozano JM. Vitamin B (12) in type 2 diabetic patients treated with metformin. Endocrinol Nutr. 2012;59(8):487-90.

Beulens JW, Hart HE, Kuijs R, Kooijman-Buiting AM, Rutten GE. Influence of duration and dose of metformin on cobalamin deficiency in type 2 diabetes patients using metformin. Acta Diabetol. 2014;52(1):47-53.

Ahmed et al. Vitamin B12 deficiency in metformin treated type-2 diabetes patients, prevalence and association with peripheral neuropathy BMC Pharmacol Toxicol. 2016;17:44.

Bell DS. Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy. South Med J. 2010;103:265-7.

Pierce SA, Chung AH, Black KK. Evaluation of vitamin B12 monitoring in a veteran population on long-term, high-dose metformin therapy. Ann Pharmacother. 2012;46:1470-6.

Caspary WF, Zavada I, Reimold W, Deuticke U, Emrich D, Willms B. Alteration of bile acid metabolism and vitamin-B12-absorption in diabetics on biguanides. Diabetologia. 1977;13:187-93.

Berchtold P, Dahlqvist A, Gustafson A, Asp NG. Effects of a biguanide (metformin) on vitamin B 12 and folic acid absorption and intestinal enzyme activities. Scand J Gastroenterol. 1971;6:751-54.

Bauman WA, Shaw S, Jayatilleke E, Spungen AM, Herbert V. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care. 2000;23:1227-31.

Ahmed MA, Muntingh GL, Rheeder P. Perspectives on peripheral neuropathy as a consequence of metformin-induced vitamin B12 deficiency in T2DM. Int J Endocrinol. 2017;2017:245-53.

Downloads

Published

2020-11-25

How to Cite

A., G., & K., K. (2020). Prevalence of vitamin B12 deficiency in type 2 diabetes mellitus patients on metformin therapy in a tertiary care hospital. International Journal of Basic & Clinical Pharmacology, 9(12), 1888–1891. https://doi.org/10.18203/2319-2003.ijbcp20205128

Issue

Section

Original Research Articles