Vitamin B12 for Diabetes Patients Treated with Metformin

Roman Pawlak

doi:10.23937/2469-5793/1510057

Abstract

Metformin treatment, both duration and dose, is associated with increased risk of vitamin B12 (B12) deficiency. B12 deficiency causes Hyperhomocysteinemia (HHcy), which is associated with an increased risk of a variety of diabetic co-morbidities. As a result, the newest “Standards of Medical Care in Diabetes - 2017,” issued by the American Diabetes Association included a recommendation to periodically assess B12 status and, as needed, utilize B12 replacement therapy among diabetes patients receiving metformin. Routine screening, using appropriate B12 assessment methods and interpretation, would enable providers to identify individuals with low B12 levels at an early stage. Prompt treatment with B12 injections or oral supplements may help in reducing the risk of low B12- and HHcy-related sequelae and their associate medical cost. The assessment of B12 status and interpretation of results is not straightforward since several B12 assessment measures are available, including serum/plasma B12, Mean Corpuscular Volume, Homocysteine, Holotranscobalamin II and Methylmalonic Acid.

Highlights

According to the recommendation issued jointly by the American Diabetes Association and the European Association for the Study of Diabetes, concurrently with lifestyle intervention, metformin therapy should be initiated at the time of diabetes diagnoses [1]
Metformin is recommended for individuals with impaired fasting glucose and/or impaired glucose tolerance who meet any of the following criteria: are < 60-years-old, have BMI ≥ 35 kg/m2, have a family history of diabetes in the first degree of relatives, have elevated triglycerides, have reduced HDL cholesterol, have hypertension, and have hemoglobin A1c > 6.0% [2]
The same may be true of elderly patients with diabetes. Both metformin dose and duration of treatment are associated with reduced B12 status

Summary

Introduction

According to the recommendation issued jointly by the American Diabetes Association and the European Association for the Study of Diabetes, concurrently with lifestyle intervention, metformin therapy should be initiated at the time of diabetes diagnoses [1]. Both duration and dose, is associated with increased risk of vitamin B12 (B12) deficiency. The newest “Standards of Medical Care in Diabetes - 2017”, issued by the American Diabetes Association included a recommendation to periodically assess B12 status and, as needed, utilize B12 replacement therapy among diabetes patients receiving metformin.

Results

Conclusion