Vitamin B12 Deficiency Among a Sample of Type 2 Diabetic Patients on Metformin in Erbil-City

Authors

  • Twana Mahmood Hamzah Trainee at Family medicine program, KHCMS; M.B.Ch.B
  • Bushra Mohammed Ali Assistant Professor. Trainer at Kurdistan Board of Medical Specialties; M.B.Ch.B, FICMS/FM

DOI:

https://doi.org/10.56056/amj.2019.73

Keywords:

Anemia, Metformin, Type 2 diabetes mellitus, Vitamin B12

Abstract

Background and objectives:Metformin is the most common oral hypoglycemic agent used as first line together with life style modification in almost all type 2 diabetes patients worldwide. The aim of the study was to determine the percentage of vitamin B12 deficiency in a sample of patients with type 2 diabetes mellitus and its association with the daily dose metformin (? 1.000 mg) and more than two years durations of treatment and anemia.

Methods:A cross-sectional study was carried out on a sample of 100 adult patients with type 2 diabetes mellitus who attended the diabetic center and two General Teaching Hospitals in Erbil city during the period from the 1st of June to the end of December 2017. Vitamin B12 level, hemoglobin concentration, and other biochemical indicators of all recruited patients were obtained.

Results: The mean age (+SD) of diabetic patients was 54.35 (± 9.71) years and the range was between 24 to 75 years. More than half of the patients (57%) had poor glycemic control and about one third (29%) of patients had vitamin B12 level less than 200 pg/ml. Patients with obesity, longer duration of disease and on high dose of metformin had a significantly higher level of vitamin B12 deficiency.

Conclusions:vitamin B12 deficiency is common among patients with type 2 diabetes mellitus especially among those using high dose of metformin for a long time. Therefore, identifying low vitamin B12 level among diabetic patients raises the concern to the patients for the future complications and challenge for the clinicians for management.

Downloads

Download data is not yet available.

References

Viollet B, Guigas B, Garcia NS, et al. Cellular and molecular mecha- nisms of metformin: an overview. Clin Sci. 2012;122(6):253-70.

Marathe PH, Gao HX, Close KL. American Diabetes Association stand- ards of medical care in diabetes 2017. J Diabetes. 2017;9(4):320-4.

Group UPDS. Effect of intensive blood-glucose control with metform- in on complications in overweight patients with type 2 diabetes (UKPDS 34). The Lancet. 1998;352(9131):854-65.

Kirpichnikov D, McFarlane SI, Sowers JR. Metformin: an update. An- nals of internal medicine. 2002;137(1):25-33.

Isoda K, Young JL, Zirlik A, et al. Metformin inhibits proinflammatory responses and nuclear factor- B in human vascular wall cells. Arterio- scler Thromb Vasc Biol. 2006;26(3):611-7.

Wulffelé eM, Kooy A, Zeeuw Dd, et al. The effect of metformin on blood pressure, plasma cholesterol and triglycerides in type 2 diabetes mellitus: a systematic review. J Intern Med. 2004;256(1):1-14.

Nathan DM, Buse JB, Davidson MB et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initia- tion and adjustment of therapy. Diabetes Spectr. 2009;22(1):6.

UK Prospective Diabetes Study Group. Effect of intensive blood-glu- cose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). The Lancet. 1998;352(9131):854-65.

Natali A, Ferrannini E. Effects of metformin and thiazolidinediones on suppression of hepatic glucose production and stimulation of glu- cose uptake in type 2 diabetes: a systematic review. Diabetologia. 2006;49(3):434-41.

Stumvoll M, Nurjhan N, Perriello G, et al. Metabolic effects of met- formin in non-insulin-dependent diabetes mellitus. New England Jour- nal of Medicine. 1995;333(9):550-4.

Scarpello JH. Optimal dosing strategies for maximising the clinical response to metformin in type 2 diabetes. The British Journal of Diabe- tes & Vascular Disease. 2001;1(1):28-36.

Misbin RI, Green L, Stadel BV, et al. Lactic acidosis in patients with diabetes treated with metformin. New England Journal of Medicine. 1998;338(4):265-6.

Aroda VR, Edelstein SL, Goldberg et al. Long-term metformin use and vitamin B12 deficiency in the Diabetes Prevention Program Out- comes Study. The Journal of Clinical Endocrinology & Metabolism. 2016;101(4):1754-61.

Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Physician. 2003;67(5):979-86.

Nygård O, Nordrehaug JE, Refsum H, et al. Plasma homocysteine levels and mortality in patients with coronary artery disease. New Eng-land Journal of Medicine. 1997;337(4):230-7.

Liu Q, Li S, Quan H, Li J. Vitamin B12 status in metformin treated patients: systematic review. PloS one. 2014;9(6):e100379.

Chapman L, Darling A, Brown J. Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes: A system- atic review and meta-analysis. Diabetes Metab. 2016;42(5):316-27.

Niafar M, Hai F, Porhomayon J, et al. The role of metformin on vitamin B12 deficiency: a meta-analysis review. Intern Emerg Med. 2015;10(1):93-102.

American Diabetes Association. Diagnosing Diabetes and Learn- ing About Prediabetes Web: American Diabetes Association; 2016. [Available from: http://www.diabetes.org/diabetes-basics/diagno- sis/?loc=db-slabnav.

Vajpayee N, Graham SS, Bem S. Basic examination of blood and bone marrow. Henry’s clinical diagnosis and management by laboratory methods. 2011;22:509-35.

Qureshi SA, Ainsworth A, Winocour PH. Metformin therapy and as- sessment for vitamin B12 deficiency: is it necessary? Practical Diabe- tes. 2011;28(7):302-4.

Khan A, Shafiq I, Shah MH. Prevalence of Vitamin B12 Deficiency in Patients with Type II Diabetes Mellitus on Metformin: A Study from Khyber Pakhtunkhwa. Cureus. 2017;9(8).

De Jager J, Kooy A, Lehert P et al. Long term treatment with met- formin in patients with type 2 diabetes and risk of vitamin B-12 de- ficiency: randomised placebo controlled trial. BMJ. 2010; 340:c2181.

Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calci- um reverses vitamin B12 malabsorption induced by metformin. Diabe- tes care. 2000;23(9):1227-31.

Briani C, Dalla Torre C, Citton V et al. Cobalamin deficiency: clinical picture and radiological findings. Nutrients. 2013;5(11):4521-39.

Iftikhar R, Qadir A, Iqbal Z, et al. Prevalence of vitamin B12 deficien- cy in patients of type 2 diabetes mellitus on metformin: a case control study from Pakistan. Pan Afr Med J. 2014;16(1).

Damião CP, Rodrigues AO, Pinheiro MF et al. Prevalence of vitamin B12 deficiency in type 2 diabetic patients using metformin: a cross-sec- tional study. Sao Paulo Med J. 2016;134(6):473-9.

Disease Control and Prevention (CDC). National Diabetes Statistics Report, 2017-Estimates of Diabetes and Its Burden in the United States Disease Control and Prevention: CDC; 2017 [Available from: https:// www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statis- tics-report.pdf.

Valuck RJ, Ruscin JM. A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and risk of vitamin B12 deficiencyin older adults. J Clin Epidemiol. 2004;57(4):422-8.

Ruscin JM, Lee Page R, Valuck RJ. Vitamin B12 deficiency associat- ed with histamine2-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother. 2002;36(5):812-6.

Pflipsen MC, Oh RC, Saguil A, et al. The prevalence of vitamin B12 deficiency in patients with type 2 diabetes: a cross-sectional study. J Am Board Fam Med. 2009;22(5):528-34.

Downloads

Published

2023-05-29

How to Cite

Hamzah, T. M. ., & Ali, B. M. . (2023). Vitamin B12 Deficiency Among a Sample of Type 2 Diabetic Patients on Metformin in Erbil-City. AMJ (Advanced Medical Journal) , 5(1), 13-18. https://doi.org/10.56056/amj.2019.73

Issue

Section

Articles