Duration Of Metformin Use Research Articles

Metformin administration in prevention of colorectal polyps in type 2 diabetes mellitus patients.

Colorectal polyps are frequently observed in patients with type 2 diabetes mellitus (DM), posing a significant risk for colorectal cancer. Metformin, a widely prescribed biguanidine drug for type 2 DM, has been suggested to have potential chemoprophylactic effects against various cancers. To explore the correlation between colorectal polyps and metformin use in type 2 DM patients. Type 2 DM patients were categorized into polyp and non-polyp groups. Following this, all patients were categorized into the type 2 DM-metformin, type 2 DM-non-metformin, and non-type 2 DM groups. Based on the baseline colonoscopy results, we performed pairwise comparisons of the incidence of colorectal polyps among the three groups. Additionally, we analyzed the relationship between colorectal polyps and the duration of metformin use and between the size and number of polyps and metformin use. Simultaneously, we focused on the specific pathological types of polyps and analyzed their relationship with metformin use. Finally, we compared the incidence of polyps between metformin and non-metformin groups according to the interval colonoscopy results. The rate of metformin use in patients with colorectal polyps was 0.502 times that of patients without colorectal polyps [odds ratio (OR) = 0.502, 95% confidence interval (CI): 0.365-0.689; P < 0.001]. The incidence of colorectal polyps did not differ significantly between the type 2 DM-metformin and non-type 2 DM groups (P > 0.05). Furthermore, the correlations between the duration of metformin use and the incidence of colorectal polyps and between the size and number of polyps and metformin use were not statistically significant (P > 0.05). Metformin use did not affect the incidence of colorectal polyps during interval colonoscopy (P > 0.05). Metformin use and colorectal polyp incidence in type 2 DM patients showed a negative correlation, independent of the hypoglycemic effect of metformin.

Effect of metformin on incidence, recurrence, and mortality in prostate cancer patients: integrating evidence from real-world studies.

Metformin has been suggested to reduce the risk of cancer. However, previous studies have been inconsistent regarding the relationship between metformin use and the risk of occurrence of prostate cancer (PCa). The purpose of this study was to assess the effect of metformin on clinical outcomes in patients with PCa in a meta-analysis and to explore the possible dose-response relationship. A systematic literature search was conducted in 10 electronic databases and 4 registries. The combined relative risks (RRs) were calculated using a random-effects model with 95% confidence interval (CIs) to assess the effect of metformin on the risk of PCa. Relevant subgroup analyses and sensitivity analyses were performed. The across studies results show that metformin use associated with lower incidence of PCa (RR: 0.82, 95% CI: 0.74-0.91). Metformin use was also found to reduce PCa recurrence, but the results were not statistically significant (RR: 0.97, 95% CI: 0.81-1.15). Metformin use was not associated with PCa mortality (RR: 0.94, 95% CI: 0.81-1.09). The results of subgroup analyses indicated that the type of study was a cohort study and the population came from both Asia and Europe showed that taking metformin reduced the incidence of PCa. A linear correlation was found between the duration of metformin use and its protective effect. This meta-analysis revealed an independent correlation between metformin use and reduced incidence of PCa. Metformin use was not associated with either PCa recurrence rate or mortality. Furthermore, the effect of metformin on PCa incidence was found to be related to duration.

Association between metformin use with circumpapillary retinal nerve fibre layer thickness and capillary vessel density in glaucoma

Background/aimsTo investigate the association between use of metformin and circumpapillary retinal nerve fibre layer (cpRNFL) thickness, as well as whole image capillary density (wiCD), in patients with glaucoma.MethodsThis cross-sectional study...

Vitamin B12 deficiency in diabetic patients treated with metformin: A cross-sectional study.

Metformin is a cornerstone medication in the management of type 2 diabetes. Metformin is safe, effective, and inexpensive; however, it is associated with vitamin B12 deficiency. This study set out to evaluate the rate of vitamin B12 deficiency in Vietnamese patients with type 2 diabetes who were treated with metformin and to investigate factors associated with vitamin B12 deficiency. This is a cross-sectional study that was conducted in Vinmec Central Park Hospital from February to June 2023. The clinical and paraclinical characteristics of the participants were recorded, and the levels of vitamin B12 and folate were measured. The rate of vitamin B12 deficiency in patients treated with metformin was found to be 18.6%. Further, the duration of diabetes, duration of metformin use, metformin dose, and hemoglobin levels were statistically associated with vitamin B12 deficiency with OR (95% CI) = 1.12 (1.03-1.19), 1.01 (1.00-1.02), 1.002 (1.001-1.002), 0.74 (0.55-0.99), respectively. After adjusting for covariates, a metformin dose greater than the median dose remained the only parameter associated with vitamin B12 deficiency, with OR (95% CI) = 4.10 (1.62-10.36). Moreover, when combining both long-term use of metformin and a metformin dose greater than the median dose, the OR increased to 5.25 (95% CI: 2.11-13.15). These results demonstrate that vitamin B12 deficiency in patients treated with metformin is quite prevalent in Vietnam and that those with long-term use of metformin (48 months or more) and high metformin dose (1000 mg/day or more) are at high risk of experiencing this adverse effect and so require screening.

Metformin and other anti-diabetic medication use and breast cancer incidence in the Nurses' Health Studies.

We aimed to examine the association between the use of metformin and other anti-diabetic medications and breast cancer incidence within two large prospective cohort studies. We followed 185,181 women who participated in the Nurses' Health Study (NHS; 1994-2016) and the NHSII (1995-2017), with baseline corresponding to the date metformin was approved for type 2 diabetes (T2D) treatment in the US Information on T2D diagnosis, anti-diabetes medications, and other covariates was self-reported at baseline and repeatedly assessed by follow-up questionnaires every 2 years. Breast cancer cases were self-reported and confirmed by medical record review. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between medication use and breast cancer were estimated using Cox proportional hazards regression models, adjusting for breast cancer risk factors. During 3,324,881 person-years of follow-up, we ascertained 9,192 incident invasive breast cancer cases, of which 451 were among women with T2D. Compared with women without T2D (n = 169,263), neither metformin use (HR = 0.97; 95% CI = 0.81-1.15) nor other anti-diabetic medications use (HR = 1.11; 95% CI = 0.90-1.36) associated with significantly lower breast cancer incidence. Among women with T2D (n = 15,918), compared with metformin never users, metformin ever use was not significantly inversely associated with breast cancer (HR = 0.92; 95% CI = 0.74-1.15). Although we observed that past use of metformin was inversely associated with breast cancer in the T2D population (HR = 0.67; 95% CI = 0.48-0.94), current use (HR = 1.01; 95% CI = 0.80-1.27) and longer duration of metformin use were not associated with breast cancer (each 2-year interval: HR = 1.01; 95% CI = 0.95-1.07). Overall, metformin use was not associated with the risk of developing breast cancer among the overall cohort population or among women with T2D.

Factors associated with an increased risk of vitamin B12 deficiency in patients with type 2 diabetes mellitus on metformin

ABSTRACTBackgroundMetformin is used to treat type 2 diabetes mellitus, but prolonged use has been associated with vitamin B12 deficiency. Many other factors have also been associated with vitamin B12 deficiency. Studies on the possible additive effect of risk factors for developing a vitamin B12 deficiency are lacking.AimThe objective of this study was to assess the correlation between other known risk factors for vitamin B12 deficiency among patients with type 2 diabetes mellitus prescribed metformin who had a vitamin B12 deficiency.MethodFor inclusion in this single‐centre, retrospective cohort study, patients needed to be at least 18 years old, diagnosed with type 2 diabetes, taking metformin for at least 2 years and actively taking metformin during the study period. The primary outcome was the rate of low B12 levels with metformin. Secondary outcomes were risk factors associated with B12 deficiency. The patient and clinical characteristics were compared between the two study groups using Student's t‐test for continuous variables and chi‐squared tests for categorical variables. This project was exempt due to the local policy requirements that constitute research by the University of Arkansas for Medical Sciences Institutional Review Board (IRB) (IRB Program Manager, 11 August 2021). The justification for this ethics exemption was as follows: the project was determined to be of minimal risk to privacy of subjects because the research team had mechanisms to protect the personal health identifiers from improper use or disclosure; to destroy the identifiers at the earliest opportunity consistent with the conduct of research, and provided assurance that the identifiers will not be re‐used or disclosed to any other person or entity, except as required by law, for authorised oversight of the research project, or for other research as permitted by the HIPAA regulations.ResultsA total of 387 patients were included in this study, from which 364 patients had a vitamin B12 deficiency. The cohort was an average 69‐years‐old and predominantly female (66%). No risk factors were associated with a higher incidence of B12 deficiency. Patient age (p = 0.0063) and time on metformin (p = 0.0144) were significantly and negatively correlated with B12 deficiency.ConclusionYounger age and shorter duration of metformin use may increase the risk of vitamin B12 deficiency. Although guidelines recommend occasional checks, only 21% of patients had vitamin B12 levels assessed during the study period.

Prevalence of Vitamin B12 deficiency in patients with type 2 diabetes mellitus on Metformin therapy at a single centre in Johannesburg, South Africa

Abstract Introduction: Metformin is a first-line oral hypoglycaemic agent for treating patients with type 2 diabetes mellitus (T2DM). Studies suggest that metformin use is associated with B12 deficiency. There is a paucity of data regarding this association in South Africa. The current study aimed to determine the prevalence of B12 deficiency in a South African cohort of T2DM patients on metformin therapy. Methods: The study was a retrospective clinical audit of patients recruited from a medical outpatient setting. A consecutive sampling technique was employed; T2DM patients who were 40 years or older and on metformin for a minimum of 6 months were recruited. B12 deficiency was defined as severe (&lt;150 pmol/L), moderate (150–169 pmol/L) or mild (170–200 pmol/L). Results: One hundred and one (n = 101) patients were enrolled, most of whom were females (65%). The prevalence of B12 deficiency was 14.9%, with most patients in the mild category. The majority of B12 deficient patients were female (67%), elderly (70.2 ±10.7 years) and of Coloured race (67%). The median duration of metformin use in B12 deficient and non-deficient patients was 10.9 (6–13) and 7 (3–12) years respectively (p =0.179). The median metformin dosage was 1700 mg. Older age (Adjusted odd ratio (AOR) 6.67 (1.16–38.3), p = 0.033) and Coloured race (AOR 7.8(1.78–34.2) p = 0.006) were associated with vitamin B12 deficiency. Conclusion: In our setting, vitamin B12 deficiency is prevalent amongst T2DM patients on metformin therapy. Older age and the novel finding of Coloured race were associated with B12 deficiency. We recommend screening for B12 deficiency amongst T2DM patients on metformin therapy.

Prevalence of vitamin B12 deficiency in patients treated with metformin

Background/Aim: Metformin has been associated with vitamin B 12 (cobalamin) deficiency, pushing scientific societies such as the American Diabetes Association and the European Association for the Study of Diabetes to emphasise the need for screening B 12 levels, without specific metformin doses or exposure durations triggering this screening. Robust data regarding the prevalence of B 12 deficiency in metformin-treated patients in Portugal are currently lacking. Aim of this study was to identify the prevalence of B 12 deficiency in a sample of diabetic patients taking metformin. Secondary objectives were determining the minimum dose and minimum and median time exposure time leading to this deficiency and identifying the average duration of metformin use in the patients with this deficiency. Methods: Descriptive and cross-sectional observational study was performed on a sample of 79 users from a population of 714 diabetic patients on metformin. Inclusion criteria comprised individuals aged 18 or older, receiving metformin for at least 1 month and voluntarily participating in the study. Exclusion criteria included a history of gastrectomy or B 12 supplementation. Results: A prevalence of 25.3 % of vitamin B 12 deficiency was identified in the study sample. Minimum doses of 500 mg of metformin per day and a minimum exposure period of 1 year were associated with B 12 deficiency. An average exposure time of 5.33 years was identified. Conclusion: These results align with the prevalence described in the few international studies and should alert physicians to potential clinical manifestations of this deficiency, such as anaemia and neurological symptoms like neuropathy.

CORRELATION AND PREVALENCE OF MEGALOBLASTIC ANAEMIA IN TYPE 2 DIABETIC PATIENTS USING METFORMIN

Background: Metformin is the most widely used drug in the management of type 2 diabetic patients but its use is associated with vitamin B12 deficiency induced megaloblastic anaemia. However few studies in Pakistan have assessed this risk. This study was conducted to determine correlation and prevalence of megaloblastic anaemia in type 2 diabetics treated with metformin. Methods: This cross-sectional study was carried out in the Department of Medicine, Hayatabad Medical Complex, Peshawar from Dec 2021 to Nov 2022. A total of 156 type 2 diabetic patients who were taking metformin at least for the last 2 years, were included in the study. All these patients were evaluated for anaemia, raised Mean Corpuscular Volume (MCV) and vitamin B12 levels. Results: Out of 156 patients who participated in the study, 94 (60.25%) were male and 62 (39.75%) were female with a mean age of 57.56±8.5 years. Mean duration of diabetes was 7.37±3.61 years, whereas mean duration of metformin use was 5.85±2.9 years. Vitamin B12 deficiency was identified in 51 (32.69%) patients. These B12 deficient patients demonstrated a mean Hb of 9.8±1.4 g/dL. Hyper-segmented neutrophils and raised MCV (mean MCV 98.7±6.90 fl was also identified in them. There was a no correlation between serum B12 levels and dose and duration of metformin. Conclusion: Long term metformin use is significantly associated with B12 deficiency associated megaloblastic anaemia. Diabetes Mellitus, Metformin, HbA1C, Vitamin B12, Megaloblastic Anaemia Pak J Physiol 2023;19(3):23–6

Role of prebiotics and probiotics in the prevention of the gastrointestinal side effects of metformin among the type 2 diabetic patients

Background: Diabetes mellitus (DM) is most common endocrine disorder all over the world. Metformin has been used as a first line drug, however, it has several gastrointestinal side effects. This study aims to determine the frequency of metformin induced gastrointestinal side effects among type 2 diabetic patients and role of prebiotics and probiotics in the prevention of the metformin-induced GI side effects. Methods: This cross-sectional study was performed in a tertiary care hospital, Rawalpindi, among 130 for one year from January 2021 to December 2022. Data was collected by applying a self-structured questionnaire. Descriptive statistics were used for the data analysis. Data analysis was performed via statistical package for the social sciences (SPSS) version 25.0. Results: The means for study variables like age, dose, and duration of therapy were 54.09 years, 1000 mg and 3.6 years respectively. Female patients had more GI side effects than male patients. Similarly, GI side effects frequency was also higher among the patients who were on metformin alone than the patients who were using metformin and combination of prebiotics and probiotics. Patients with higher dose of metformin and shorter duration of metformin therapy had higher frequency of GI symptoms. The most common GI symptom was constipation followed by diarrhea, bloating, abdominal pain, vomiting/nausea, dyspepsia, loss of appetite and flatulence. Conclusions: Metformin induced GI symptoms were common among study population. Use of prebiotics and probiotics combination with metformin, low dose of metformin, and longer duration of metformin use were found protective against the metformin-induced GI side effects.

Prevalence and determinants of Vitamin B12 deficiency among subjects with Type 2 Diabetes in a tertiary institution in Southeast Nigeria

Vitamin B12 (Vit B12) deficiency is very common among diabetic subjects, although with variable prevalence. The aim of this study is to determine the prevalence of Vit B12 deficiency and its associated factors among patients with Diabetes Mellitus (DM). This study is important because Vit B12 deficiency is associated with metformin, which is a bedrock in the management of diabetic subjects. Since peripheral neuropathy is a recognized complication of DM, and also occurs in Vit B12 deficiency, it would be important to ascertain the role of Vit B12 deficiency in the emergence of peripheral neuropathy. Appropriate measures like vitamin supplementation would then be instituted in diabetics who are on metformin. A cross-sectional study was conducted at Enugu State University Teaching Hospital in Enugu, Nigeria, between January to July 2019. A total of 422 patients who fit the eligibility criteria were included in the study. Data on demographics, medication use, and anthropometry were obtained from each subject, while blood was drawn to study Vit B12 levels, Haemoglobin (Hb), Mean Cell Volume (MCV), and Glycated Heamoglobin (HbA1c). Vitamin B12 deficiency was defined as serum B12 level of ≤200 pg/mL. The prevalence of vitamin B12 deficiency among Type 2 DM patients was 16.6% (n=364). Predictors of Vit B12 deficiency in Type 2 diabetic subjects included duration of metformin use of more than five years (p&lt;0.0001). Other predictors of vitamin B12 deficiency include Body Mass Index (BMI), diabetes duration, and macrocytic anemia. This study suggests that the prevalence of Vit B12 deficiency among patients with DM in our population is substantial. This is more frequent among patients who have been on metformin for more than five years.

Vitamin B12 deficiency in long-term metformin treated type 2 diabetic patients: Prevalence and risk factors in a Tunisian population.

Objectives: To determine the prevalence of vitamin B12 deficiency in a Tunisian population with type 2 diabetes (T2D) on metformin treatment for more than three years and to identify its risk factors. Methods: This is a cross-sectional study conducted on 257 patients with T2D treated with metformin for at least three years. Patients were divided into two groups according to their vitamin B12 status. Low vitamin B12 was defined as ≤ 203 pg/mL. Results: The mean age of the patients was 59.8 ± 7.9 years. The mean duration of metformin use was 10.2 ± 5.2 years. The mean vitamin B12 level was 294.9 ± 156.4 pg/mL. The prevalence of vitamin B12 deficiency was 28.4%. Male gender, HbA1c < 7% and hyperhomocysteinemia were significantly associated with vitamin B12 deficiency (respectively p = 0.02, p < 0.001, p < 0.001). Homocysteine level was negatively correlated with vitamin B12 level (r = -0.2, p = 0.001). Dose and duration of metformin treatment, peripheral neuropathy and anemia were not associated with vitamin B12 deficiency. On multivariate analysis, HbA1c < 7% and hyperhomocysteinemia were independently associated with vitamin B12 deficiency (respectively OR = 3.2, 95%CI = [1.6-6.3] and OR = 2.3, 95%CI = [1.2-4.2]). Discussion: The prevalence of vitamin B12 deficiency in patients with T2D on metformin treatment was high. Hyperhomocysteinemia is associated with vitamin B12 deficiency suggesting that the deficit occurs at the tissue level.

Post-diagnostic metformin and statin use and risk of biochemical recurrence in Veterans diagnosed with prostate cancer.

To evaluate the impact of post-diagnostic metformin or statin use and duration on risk of biochemical recurrence in a racially-diverse cohort of Veterans. The population consisted of men diagnosed with prostate cancer in the Veterans Health Administration and treated with either radical prostatectomy or radiation (Full cohort n = 65,759, Black men n = 18,817, White men n = 46,631, Other = 311). The association between post-diagnostic (1) metformin and (2) statin use with biochemical recurrence was assessed using multivariable, time-varying Cox Proportional Hazard Models for the overall cohort and by race. In a secondary analysis, metformin and statin duration were evaluated. Post-diagnostic metformin use was not associated with biochemical recurrence (multivariable-adjusted hazard ratio [aHR]: 1.01; 95% confidence interval [CI]: 0.94, 1.09), with similar results observed for both Black and White men. However, duration of metformin use was associated with a reduced risk of biochemical recurrence in the cohort overall (HR: 0.94; 95% CI: 0.92, 0.95) as well as both Black and White men. By contrast, statin use was associated with a reduced risk of biochemical recurrence (HR: 0.83; 95% CI: 0.79, 0.88) in the overall cohort as well as both White and Black men. Duration of statin use was also inversely associated with biochemical recurrence in all groups. Post-diagnostic metformin and statin use have the potential to prevent biochemical recurrence in men diagnosed with prostate cancer.

EVALUATION OF SERUM VITAMIN B12 LEVELS IN TYPE 2 DIABETES MELLITUS PATIENT ON METFORMIN THERAPY ATTENDING A TERTIARY CARE HOSPITAL

Background: Metformin for type 2 diabetes mellitus has more beneficial effect with few side effects like vitamin B12 deficiency. So, this study aimed to determine the level of vitamin B12 in patients with type 2 diabetes mellitus using metformin and its association with dose and duration of metformin use. Methods: This was descriptive, cross-sectional, hospital-based study. A total of 128 diabetic patients using metformin for more than 6 months were enrolled. After taking informed consent, considering exclusion criteria, level of serum B12 were quantified by chemiluminescent enzyme immunoassay. Vitamin B12 level &lt;300pg/dl as inadequate and ≥300pg/dl as adequate; metformin 1000mg as low dose; more than 1000mg as high dose were considered. Also, metformin used 1000mg /day taken as constant and comparing it with duration of &gt; 10 years with duration of &gt; 10 years. Data were entered in Microsoft Excel 2013 and analyzed on SPSS V25. Results: Our study results 62.5% had adequate (&gt;300pmol/l) and 37.5% had inadequate (≤300pmol/l) vitamin B12 level in patients with type 2 diabetes using metformin. Level of vitamin B12 deficiency was statistically associated with increasing dose of metformin used (p&lt;0.001) and long term used of metformin used (p&lt;019). Conclusions: This study concluded that there is prevalence of deficiency of Vit B12 level in type 2 diabetes mellitus patients using metformin. Also, this deficiency level depends on use of dose of metformin.

Association of Metformin With the Development of Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a leading cause of blindness with no treatment available for early stages. Retrospective studies have shown an association between metformin and reduced risk of AMD. To investigate the association between metformin use and age-related macular degeneration (AMD). The Diabetes Prevention Program Outcomes Study is a cross-sectional follow-up phase of a large multicenter randomized clinical trial, Diabetes Prevention Program (1996-2001), to investigate the association of treatment with metformin or an intensive lifestyle modification vs placebo with preventing the onset of type 2 diabetes in a population at high risk for developing diabetes. Participants with retinal imaging at a follow-up visit 16 years posttrial (2017-2019) were included. Analysis took place between October 2019 and May 2022. Participants were randomly distributed between 3 interventional arms: lifestyle, metformin, and placebo. Prevalence of AMD in the treatment arms. Of 1592 participants, 514 (32.3%) were in the lifestyle arm, 549 (34.5%) were in the metformin arm, and 529 (33.2%) were in the placebo arm. All 3 arms were balanced for baseline characteristics including age (mean [SD] age at randomization, 49 [9] years), sex (1128 [71%] male), race and ethnicity (784 [49%] White), smoking habits, body mass index, and education level. AMD was identified in 479 participants (30.1%); 229 (14.4%) had early AMD, 218 (13.7%) had intermediate AMD, and 32 (2.0%) had advanced AMD. There was no significant difference in the presence of AMD between the 3 groups: 152 (29.6%) in the lifestyle arm, 165 (30.2%) in the metformin arm, and 162 (30.7%) in the placebo arm. There was also no difference in the distribution of early, intermediate, and advanced AMD between the intervention groups. Mean duration of metformin use was similar for those with and without AMD (mean [SD], 8.0 [9.3] vs 8.5 [9.3] years; P = .69). In the multivariate models, history of smoking was associated with increased risks of AMD (odds ratio, 1.30; 95% CI, 1.05-1.61; P = .02). These data suggest neither metformin nor lifestyle changes initiated for diabetes prevention were associated with the risk of any AMD, with similar results for AMD severity. Duration of metformin use was also not associated with AMD. This analysis does not address the association of metformin with incidence or progression of AMD.

Effect of Metformin on Vitamin B12 Deficiency in Patients With Type 2 Diabetes Mellitus and Factors Associated With It: A Meta-Analysis.

The current meta-analysis aims to explore the effect of metformin use on vitamin B12 deficiency in patients with type 2 diabetes mellitus (T2DM) and the factors associated with it. This meta-analysis followed the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines.We searched PubMed and EMBASE from January 1, 2010, to October 31, 2022, to collect the studies that reported the effect of metformin on the deficiency of vitamin B12 in patients with T2DM and the factors associated with it. A total of 17 studies were included in the current meta-analysis. Among all the included studies, 13 were cross-sectional studies, 3 were retrospective cohorts, and one was a case-control study. The pooled rate of deficiency of vitamin B12 in patients receiving metformin (23.16%) was significantly higher compared to patients who were not on metformin (17.4%) (OR: 2.95, 95% CI: 2.18-4.00, p-value: 0.001). Factors significantly associated with vitamin B12 deficiency in patients with T2DM and receiving metformin include the duration of metformin use and a greater dose of metformin. In conclusion, our meta-analysis found that the prevalence of vitamin B12 deficiency is greater in patients receiving metformin compared to patients who did not receive metformin. Given the importance of vitamin B12 in nutrition, metformin-induced B12 decrease may be harmful to patients with T2DM. Supplemental vitamin B12 may be advantageous for those on metformin.

CLINICAL AND BIOCHEMIICAL MANIFESTATIONS OF VITAMIN B12 DEFICIENCY IN TYPE 2 DIABETIC PATIENTS TREATED WITH METFORMIN- A COMPARATIVE STUDY

Objectives: The objective of this study was to estimate the occurrence of Vitamin B12 deficiency in patients with type 2 diabetes mellitus treated with metformin, and the clinical and biochemical profile of vitamin B12 deficiency in them. Materials and Methods: This was a cross sectional study. Type 2 Diabetics over the age of 18 years were recruited for the study. Patients were divided into two groups - one groupof 62 patients who were on metformin for more than 6 months and the other group of 62 patients who were on other oral hypoglycemic agents or insulin. Patients were interviewed using a questionnaire. Relevant blood investigations were done. Results: The mean (+SD) age of study population was 57 (±9.8) years with an age range of 35 to 79 years. There was high prevalence of vitamin B12 deficiency in patients with type 2 diabetic mellitus treated with metformin (22.6%)(p-value&lt;0.001). This study showed a statistically significant inverse relationship between duration of metformin use and vitamin B12 levels (p-value 0.01). There was a statistically significant correlation between the dose of metformin and vitamin B12 deficiency – the higher the dose, the lower the average vitamin B12 level (p-value 0.02). The study revealed significantly increased neuropathic symptoms in Type 2 Diabetic patients on metformin with B12 deficiency than with normal B12 levels (p-value&lt;0.001). Conclusions: This study demonstrated a high prevalence of vitamin B12 deficiency in patients with type 2 diabetic patients treated with metformin (22.6%). Hencethe measurement of vitamin B12 should become an essential part of the annual review in all patients with type 2 diabetic patients on metformin therapy. The study revealed significantly increased neuropathic symptoms in Type 2 Diabetic patients on metformin with B12 deficiency than with normal B12 levels.

PSUN222 Prevalence of Vitamin B12 Monitoring Among Patients Receiving Metformin in a Public Hospital

Abstract Background Metformin reduces intestinal absorption of Vitamin B12 in up to 30% of patients and lowers serum Vitamin B12 concentrations in 5-10%. The dose and duration of metformin use correlates with the risk of Vitamin B12 deficiency. Low serum levels may be detected as early as 3-4 months after starting metformin; however, symptomatic deficiency is more likely to present after 5-10 years of metformin therapy. In 2017, the American Diabetes Association (ADA) updated its treatment guidelines to recommend patients taking metformin undergo regular monitoring of Vitamin B12 levels. To better understand acceptance and application of these guidelines, we undertook an assessment of such monitoring within a single hospital center serving the low-income population in Atlanta, GA to assist in guiding optimal monitoring and patient management. Methods Data was collected from a single hospital center using electronic medical records (EMR) and the SlicerDicer tool to identify all outpatients for whom metformin was prescribed either as a single agent or in combination therapy during January 1 – December 31, 2021 and then measure Vitamin B12 prescribing among two cohorts during the same time period: primary care patients and patients followed by the diabetes center. Results During the period studied, of the total 2,336,914 patients documented in the EMR, 30,803 (0.01%) were outpatients whom metformin had been prescribed either as a single agent or in combination therapy. Of these, 816 patients (2.6%) had Vitamin B12 levels ordered and measured. The prevalence of Vitamin B12 levels ordered and measured was greater among primary care patients (673 of 8,971 [7.5%]) when compared with patients followed by the diabetes center (25 of 1,081 [2.3%]) (chi-square p&amp;lt;0.001). A second analysis determined that Vitamin B12 levels were abnormally low among 172 (23.7%) primary care patients and 25 (28%) patients followed by the diabetes center (chi-square p=0.78). Conclusion Our study determined that among two outpatient cohorts who were prescribed metformin there was suboptimal adherence to the ADA's recommendation for regular monitoring of Vitamin B12 levels. The findings of this study will be used to develop approaches for increasing and optimizing ordering and monitoring Vitamin B12 levels for patient care management. Increased awareness of the relationship between metformin and Vitamin B12 deficiency and standardized approaches to monitoring are needed. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Metformin Use before Influenza Vaccination May Lower the Risks of Influenza and Related Complications.

Older adults are more likely to have influenza and respond less well to the flu vaccine. We conducted this study to investigate whether pre-influenza vaccination metformin use had an effect on influenza and relevant complications in older adults with type 2 diabetes mellitus. Propensity score matching was used to identify 28,169 pairs of metformin users and nonusers from Taiwan’s National Health Insurance Research Database from 1 January 2000 to 31 December 2018. We used Cox proportional hazards models to calculate the risks of hospitalization for influenza, pneumonia, cardiovascular disease, ventilation, and mortality between metformin users and nonusers. Compared with metformin nonusers, the aHRs (95% CI) for metformin users at risk of hospitalization for influenza, pneumonia, cardiovascular disease, invasive mechanical ventilation, death due to cardiovascular disease, and all-cause mortality were 0.60 (0.34, 1.060), 0.63 (0.53, 0.76), 0.41 (0.36, 0.47), 0.56 (0.45, 0.71), 0.49 (0.33, 0.73), and 0.44 (0.39, 0.51), respectively. Higher cumulative duration of metformin use was associated with lower risks of these outcomes than no use of metformin. This cohort study demonstrated that pre-influenza vaccination metformin use was associated with lower risks of hospitalizations for influenza, pneumonia, cardiovascular disease, mechanical ventilation, and mortality compared to metformin nonusers.

Metformin and the Risk of Chronic Urticaria in Patients with Type 2 Diabetes.

We conducted this study to determine the effect of metformin use on the risk of new-onset chronic urticaria in patients with type 2 diabetes (T2D). In total, 24,987 pairs of metformin users and nonusers were identified with propensity score-matching from Taiwan’s National Health Insurance Research Database from 1 January 2000, to 31 December 2017. Multivariable Cox proportional hazards models were used to compare the risks of chronic urticaria development, severe chronic urticaria, and hospitalization for chronic urticaria between metformin users and nonusers. Compared with metformin nonuse, the aHRs (95% CI) for metformin use in chronic urticaria development, severe chronic urticaria, and hospitalization for chronic urticaria were 1.56 (1.39–1.74), 0.40 (0.12–1.30), and 1.45 (0.82–2.56), respectively. The cumulative incidence of chronic urticaria development was significantly higher in metformin users than in nonusers (p < 0.0001). A longer average cumulative duration of metformin use was associated with higher risks of new-onset and hospitalization for chronic urticaria than metformin nonuse. This nationwide cohort study showed that metformin use was associated with a significantly higher risk of chronic urticaria development. A longer average cumulative duration of metformin use was associated with a higher risk of outcomes. More prospective studies are needed to verify our results.