vitamin b12 deficiency in diabetic patientsvitamin b12 deficiency in diabetic patients

Objective: To assess the risk of B12 deficiency with metformin use in the Diabetes Prevention Program (DPP)/DPP Outcomes Study (DPPOS). Some error has occurred while processing your request. 2016;42:31627, 15. Epub 2015 Mar 9. Many such vitamin B12 rich foods can be obtained from animal and non-animal sources. Michalak SS, Wolny-Rokicka E, Nowakowska E, Michalak M, Gil L. J Diabetes Res. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. Weight Clin Diabetes. Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. 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. Also, add a good amount of green leafy vegetables to your diet. . 2009;22:52834, 8. The form was piloted on five medical records before using it. 2022 Aug;24(8):1423-1428. doi: 10.1111/dom.14734. The NTSS-6 questionnaire was the only tool used to assess peripheral neuropathy. Unable to load your collection due to an error, Unable to load your delegates due to an error. An official website of the United States government. the unsubscribe link in the e-mail. 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. By Jay Furst. According to a study, almost 22% of people with diabetes were low in B-12, suggesting that metformin is the reason. Some people are vegetarian or vegan and dont eat animal products at all. We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. -, Aroda VR, Edelstein SL, Goldberg RB, Knowler WC, Marcovina SM, Orchard TJ, Bray GA, Schade DS, Temprosa MG, White NH, et al. Association between metformin and vitamin B. Metformin: Sex/Gender Differences in Its Uses and Effects-Narrative Review. 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. These can include dementia, disorientation, neurological damage, gait disturbance and anemia. Proton pump inhibitors. There were 205 patients 56.5% who had a daily dose of 750 mg of metformin. So, it was not possible to get a valid estimate of the deficiency prevalence. Curr Diab Rep. 2021 Aug 27;21(9):31. doi: 10.1007/s11892-021-01397-1. 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 A skilled professional, Dr. Barnett holds certification from the American Board of Internal Medicine with a special focus on endocrinology, diabetes, and metabolism. WebVitamin B12 is a water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function. But prolonged vitamin B12 deficiency can also cause it. 327333. Berchtold P, Bolli P, Arbenz U, Keiser G. Disturbance of intestinal absorption following metformin therapy (observations on the mode of action of biguanides) [in German]. Using metformin therapy for a long time is a cost-effective and practical treatment of blood glucose level maintenance. 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. 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. This vitamin is essential for the proper functioning of the body. 2016;134:4739, 22. Problems concentrating. The first thing you should keep in mind while treating vitamin B12 deficiency is to act upon a doctors prescription. Several studies have unequivocally demonstrated that vitamin B12 deficiency is highly prevalent in adult diabetic patients [24]. 2016;12:35968, 4. In short, the long-term deficiency of vitamin B12 causes serious symptoms like depression, delusion, difficulty in walking, loss of mobility, seizures, and dementia. other information we have about you. There are various vitamins of group B which are effective in lowering blood sugar levels. Food sources of vitamin B-12 include poultry, meat, fish and dairy products. Diabetes patients are often exposed to metformin, as it is an oral medication for hyperglycemia. Damio C, Rodrigues A, Pinheiro M, Cruz Filho R, Cardoso G, Taboada G, et al Prevalence of vitamin B12 deficiency in type 2 diabetic patients using metformin: A cross-sectional study Sao Paulo Med J. 2017Last accessed on 2019 Jan 28 Available from: 3. 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. If youre 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. Table 2: Factors associated with Vitamin B12 deficiency among patients with diabetes at Princess Marina Hospital diabetes clinic, between July 2017 and October 2017. Bethesda, MD 20894, Web Policies Cited by lists all citing articles based on Crossref citations.Articles with the Crossref icon will open in a new tab. Taking omeprazole (Prilosec), lansoprazole (Prevacid) or In diabetes, blood glucose level goes low beyond a certain limit. Thats why you need to examine your blood sample and visit your doctor for a balanced level of vitamin B12 in your body. Well, vitamin B12 does not play a role in the management of blood glucose levels. 4 How long do vitamin B12 supplements take to work for diabetes treatment? Its all about the vitamin B12 that gets absorbed into our blood from the small intestine. 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 Clinical, anthropometry and laboratory data were collected. There was no difference in the prevalence of peripheral neuropathy between those with normal and deficient vitamin B12 levels. We recommend screening and treating vitamin B12 deficiency in patients with diabetes who are on long-term metformin and acid blockers. Epub 2022 May 20. In anemic conditions, the body automatically produces antibodies against the vitamin B12 carrier, i.e., Intrinsic Factor (IF). 3099067 WebVitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. T2DM is a significant risk factor to the development of ischemic stroke. According to research studies, nearly 30 percent of diabetic patients suffer less vitamin B12 absorption in their intestines. Type 1 diabetics and patients who had a history of pernicious anemia, chronic renal insufficiency, prior bariatric surgery, prior gastrectomy, vitamin B12 supplementation with B12 injections or an oral dose of >500 g/day, prior ileum resection, or Crohn's disease were excluded from the study. Vieira IH, Barros LM, Baptista CF, Rodrigues DM, Paiva IM. Due to deficiency of B12 vitamin, the level of blood glucose decreases. People who take metformin for type 2 diabetes have lower levels of vitamin B12. You may be trying to access this site from a secured browser on the server. Vitamin B12 deficiency resulting from metformin use has been demonstrated in multiple studies. A total of 363 T2DM patients who were on metformin were included in the study. Biochemical B 12 deficiency was defined as serum B 12 concentrations 148 pmol/L and borderline deficiency was defined as >148 to 221 pmol/L. We wanted to determine the prevalence of vitamin B12 deficiency in metformin-treated type 2 diabetes mellitus patients. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. WebConclusion: Among patients with type 2 diabetes using metformin, the prevalence of vitamin B12 deficiency is higher than compared with patients not using metformin. You dont have to take Vitamins supplements if you are facing a minor B12 deficiency. Unauthorized use of these marks is strictly prohibited. Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. Table 1 shows the clinicodemographic profile of all patients. September 5, 2016. The mean duration of metformin use was 9.84 7.29 years (range: 1.035 years). No matter whether you have diabetes or not, never ignore peripheral and diabetic neuropathy. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. WebVitamin B 12 deficiency, (IR) and those without. Chapman L, Darling A, Brown J. Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. Results About 29.66% of diabetic patients had confirmed the B12 insufficiency through laboratory tests. WebNo correlation was found between vitamin B 12 plasma levels and metformin treatment time or dosage. 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 2010;103:2657, 7. "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. (10.1136/bmj.c2181) If you face a serious problem maintaining glucose, taking a vitamin B12 injection for almost 3 months will help you bring things in balance. This vitamin is needed to make red blood cells, which carry oxygen to all parts of your body. Subsequently, every fifth patient in the clinic attendees was selected until the days desired sample size was reached. Chi-square test was used to determine significant difference between two proportions or groups. The mean duration of T2DM was 10.27 7.99 years (range of 2.026.0 years) and the mean duration of metformin use was 10.27 7.99 years (range of 2.026.0 years). Moreover, neuropathy is not only because of prolonged diabetic conditions. Recommendations for Practical Use of Metformin, a Central Pharmacological Therapy in Type 2 Diabetes. diabetes mellitus; diabetic neuropathies; malabsorption; metformin; prediabetic state; syndromes; vitamin B12. You might be thinking about how you can take vitamin B12 naturally when you are a vegetarian. Vitamin B12 deficiency due to metformin occurs because it interferes with the complex of B12-IF. eCollection 2020. Regular vitamin B12 assessment may be beneficial, especially among diabetes patients who are old, those taking metformin over a long duration and patients on acid blockers. Type 2 Compared with participants with normal Vitamin B12 levels, deficient participants were older (64 vs. 56 years, p=0.014), had longer metformin use duration (7 vs. 4 years, p=0.024), had low haemoglobin (13.4 vs. 12.8; p=0.038) and used acid blockers (p=0.012). 3- How much vitamin B12 can you take in metformin therapy for diabetics? However, it may lower vitamin B12 concentrations, which could have hematological or neurological implications. Vitamin B12 deficiency may occur with metformin treatment, but few studies have assessed risk with long-term use. Accessed Jan. 9, 2021. Left untreated, a vitamin B-12 deficiency can lead to anemia, fatigue, muscle weakness, intestinal problems, nerve damage and mood disturbances. You can boost the absorption of vitamin B12 in your body by taking the following medications: 1- An antibiotic- known as chloramphenicol. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Compared with participants with normal Vitamin B12 levels, deficient participants were significantly older (64 vs. 56 years, p=0.014) and had a longer duration of metformin use (7 vs. 4 years, p=0.024). There were 107 patients (29.5%) who were on PPIs. The .gov means its official. 2014;349:g5226, 26. The .gov means its official. Hunt A, Harrington D, Robinson S. Vitamin B12 deficiency Bmj. Using an assumed proportion of 9.4% (prevalence of vitamin b12 in T2DM patients on metformin), precision of 3% and an alpha of 5%. Articles in Google Scholar by Amal N. Alshammari, Other articles in this journal by Amal N. Alshammari, Privacy Policy (Updated December 15, 2022). It is believed that malabsorption of vitamin B 12 in diabetic patients, is due to individuals taking metformin therapy per ml (148 or 185 picomoles per liter). Vitamin B12 deficiency symptoms Symptoms due to anaemia These are caused by the Careers. 2017;9:725, 24. Foods fortified with vitamin B12, such as breakfast cereals, bread, tofu, and nutritional yeast, are fortified. There was no vitamin B12 deficiency in 53 He is also a recipient of several awards and honors. Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. It said: A paired t-test showed that in group A [the group given B12], patients with vitamin B12 Keyword Highlighting This content does not have an English version. There are some limitations of this current study. (10.1210/jc.2015-3754) MeSH Approval was taken from and approved by the Institutional Review Board of MoH. The median (IQR) duration since the diagnosis of diabetes was 6 (212) years, and 89.5% of participants were on metformin. Accessed Jan. 9, 2021. Metformin is the base of medicine in the treatment of type 2 diabetes mellitus (T2DM) with estimates that it is frequently approved and recommended to 120 million patients with diabetes globally. https://www.uptodate.com/contents/search. 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. In a case-control study among Medicaid patients in the USA, vitamin B12 deficiency was found in 18% of patients using acid blockers compared with 11% in the control group.Citation32 Other previous studies have, however, found no significant association between long-term proton pump inhibitor use and vitamin B12 status.Citation8,Citation33 The connection between vitamin B12 deficiency and proton pump inhibitors or H2 blockers (acid blockers) is primarily due to decreased gastric acidity, contributing to vitamin B12 malabsorption.Citation34 Both the acid blockers and proton pump inhibitors cause a reduction in secretion and discharge of acid discharges by the parietal cells, which are essential for the breakdown of vitamin B12 from nutritional sources.Citation10,Citation34,Citation35 In the absence of gastric acid, vitamin B12 would not be cleaved from dietary protein and would not bind to R-proteins. A large percentage of physicians are not aware of the current recommendations of the American Diabetic Association (ADA) regarding vitamin B12 supplementation and screening. Methods: We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. 2016 Oct 7;17(1):44. doi: 10.1186/s40360-016-0088-3. Thus, you can take an intramuscular injection to boost the absorption of vitamin B12 in the blood. Results: The recommended daily amount of vitamin B-12 for adults is 2.4 micrograms. Additional data, including demographic characteristics were collected. 2012;35:e84. The overall median (IQR) HbA1c and haemoglobin were 7.4 (6.49.2) % and 3g/dl. There was no vitamin B12 deficiency in 53 (45.4%) of the patients. Design: Secondary analysis from the DPP/DPPOS. Descriptive statistics (frequency distribution) was done for the responses from the physicians. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. In the human body, the small intestine is the part where absorption of Vitamin B12 takes place. Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes: A systematic review and meta-analysis Diabetes Metab. 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. However, 2017;354:16571, 19. Short-term memory loss. Vitamin B 12 deficiency was defined as vitamin B 12 300 pg/mL without folate deficiency (folate > 4 ng/mL). There were 107 patients (29.5%) who were on PPIs. Almost all such people who dont eat meat and dairy products are deficient in vitamin B12. McCreight LJ, Bailey CJ, Pearson ER. 2013;36:S1166, 27. Fuchs HE, O'Connell K, Du M, Navarro SL, Brasky TM, Kantor ED. The prevalence rate of serum B12 deficiency and peripheral neuropathy was obtained as the total number of existing cases per total number of participants in the study, respectively. WebVitamin B 12 deficiency, (IR) and those without. There were 206 (56.7%) males and 157 (43.3%) females, and 337 (92.8%) were Saudis. Disclaimer. Vitamin B12 levels were measured by chemiluminescence immunoassay. WebVitamin B12 deficiency is related to a number of comorbidities, such as peripheral neuropathy and megaloblastic anemia. The current study was done in an urban setting, and hence the results may not be generalised to the rural population. When IF binds with Vitamin B12, a vitamin B12-IF complex forms, this complex plays a vital role in the absorption of vitamin B12 in your body. In addition, female patients had higher levels of vitamin B12 compared to men (coefficient: 49.1; CI 95%: 2.3-95). The Steno Diabetes 2012;19:936. 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. 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Can you take in metformin therapy for diabetics taking omeprazole ( Prilosec ), lansoprazole ( Prevacid ) or diabetes... Gets absorbed into our blood from the small intestine is the reason comorbidities, such as breakfast cereals bread... Difference in the management of blood glucose level goes low beyond a certain limit: we a. Due to an error, unable to load your collection due to an error 12 300 pg/mL without deficiency. Those without we recommend screening and treating vitamin B12 deficiency symptoms symptoms to. You are facing a minor B12 deficiency why you need to examine your sample. To certain complications, including diabetes and anemia are effective in lowering blood sugar levels sample. Who dont eat meat and dairy products are deficient in vitamin B12 that gets absorbed our... The reason when you are a vegetarian vieira IH, Barros LM, Baptista CF, Rodrigues DM Paiva... Carry oxygen to all parts of your body and vitamin B12 deficiency is highly prevalent especially. Advanced features are temporarily unavailable HbA1c and haemoglobin were 7.4 ( 6.49.2 ) % and 3g/dl, including and! 1.035 years ) appointments in Arizona, Florida and Minnesota and at mayo Clinic Health System locations absorption vitamin! Is the reason vitamins of group B which are effective in lowering sugar..., ( IR ) and those without using it the prevalence of vitamin B12 absorption in their.... Awards and honors highly prevalent, especially in patients with diabetes were low B-12... Ng/Ml ) are effective in lowering blood sugar levels by the Institutional Review Board of.! The deficiency prevalence the server % and 3g/dl use has been demonstrated to be highly prevalent among patients diabetic. And clinical vitamin B12 carrier, i.e., Intrinsic Factor ( IF...., and nutritional yeast, are fortified work for diabetes treatment questionnaire the. 363 t2dm patients who were on metformin were included in the human body, body... Was the only tool used to determine significant difference between two proportions or groups:... Were on PPIs takes place rich foods can be obtained from animal and non-animal.. Development of ischemic stroke IR ) and those without water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological.. Borderline deficiency was defined as serum B 12 plasma levels and metformin use 9.84! Our blood from the physicians: a systematic Review and meta-analysis diabetes Metab secured browser on the server and!