SAT-148 Vitamin B12 Deficiency Among Patients with Metformin and Diabetic Neuropathy.

Abstract

Introduction: Vitamin B12 deficiency due to metformin use has been demonstrated in multiple studies with variable prevalence. There are no studies in our population that demonstrate the prevalence of vitamin B12 deficiency in patients with metformin and diabetic neuropathy. The objective of this study is to describe its prevalence and the characteristics of the patients who present vitamin B12 deficiency. Methodology: Cross sectional study. 162 patients were included. The level of vitamin B12 was considered low, less than 200 pg / ml and borderline, 201 to 300 pg / ml. The level of vitamin B12 was analized according to age, sex, metformin dose, metformin time of use, time from the diagnosis of diabetes or prediabetes and the presence of diabetic neuropathy. A linear regression model was used to evaluate the variables that correlate with vitamin B12 levels. Results: 162 patients were collected. An altered level of vitamin B12 was found in 29% (CI95%: 22% to 36%) and a low level of vitamin B12 in 7.3% (CI 95%: 4.0% to 12%). In patients with diabetic neuropathy the prevalence of altered B12 levels was 64% (95% CI 47-78%), while in patients without diabetic neuropathy it was 17% (95% CI 10-26%). Patients with diabetic neuropathy had lower levels of vitamin B12 compared with patients without neuropathy (coefficient -110.8, CI 95%: -165.8 to -59.7). A higher dose of metformin showed correlation with lower levels of vitamin B12 (coef -0.061 CI 95%: - 0.09 to -0.024). Female patients had higher levels of vitamin B12 compared to men (coef 49.1 CI 95%: 2.3 to 95). Conclusions: Vitamin B12 deficiency is frequent in our population of patients treated with metformin, with prevalences higher than those described in other populations. Patients with diabetic neuropathy have much higher prevalence of vitamin B12 deficiency. Male patients with higher doses of metformin and patients with diabetic neuropathy have the lowest levels of vitamin B12. More studies are needed to establish an association between vitamin b12 deficiency and diabetic neuropathy. Bibliography 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]. Diabetologia. 1969;5:405- 412. Aroda VR, Edelstein SL, Goldberg RB. Diabetes Prevention Program Research Group. Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study. J ClinEndocrinolMetab. 2016 Apr; 101(4): 1754-1761. Reinstatler L, Qi YP, Williamson RS, et al. Association of biochemical B₁₂ deficiency with metformin therapy and vitamin B₁₂ supplements: the National Health and Nutrition Examination Survey, 1999-2006.Diabetes Care. 2012 Feb;35(2):327-33.1. Roy RP, Ghosh K, Ghosh M; et al. Study of vitamin B12 deficiency and peripheral neuropathy in metformin treated early Type 2 diabetes mellitus. Indian J EndocrinolMetab. 2016; 20(6): 895.