Vitamin B12 Deficiency In Type Research Articles

Evaluating Physician Knowledge, Attitudes, and Practices in Screening and Supplementation for Vitamin B12 Deficiency in Type 2 Diabetes Patients Treated with Metformin.

Long-term metformin use in Type 2 Diabetes Mellitus (T2DM) patients is associated with Vitamin B12 deficiency. This study aims to evaluate physicians' knowledge, attitudes, and practices regarding Vitamin B12 screening and supplementation in this context. A survey was administered to physicians across various specialties in government hospitals and primary care centers in Riyadh, Saudi Arabia, from January 2019 to January 2020. The survey assessed their knowledge, attitudes, and practices concerning Vitamin B12 deficiency screening and supplementation. Of the 402 participating physicians, 94.0% (378 respondents) demonstrated sufficient knowledge about Vitamin B12 deficiency. However, 26.1% believed that Vitamin B12 supplementation does not necessitate screening. 55.7% did not prescribe Vitamin B12 prophylactically, 41.5% omitted neurological examinations in patients presenting with neuropathy, and 22.4% were unaware of the recommended Vitamin B12 supplement dose. Only 49.8% routinely screened for Vitamin B12 deficiency in symptomatic patients. Physicians with more extended years of experience showed significantly better knowledge about Vitamin B12 screening and supplementation (p<0.001). While most physicians were knowledgeable about Vitamin B12 deficiency and supplementation, a substantial gap in translating this knowledge into practice was observed. There is a critical need for institutional oversight to ensure adherence to American Diabetes Association (ADA) guidelines for Vitamin B12 screening and supplementation in T2DM patients on long-term metformin therapy.

Prevalence of vitamin B12 deficiency in type 2 diabetic patients: A review

Prevalence of vitamin B12 deficiency in type 2 diabetic patients: A review

Prevalence of vitamin B12 deficiency in type 2 diabetic patients taking metformin, a cross-sectional study in primary healthcare.

Several studies documented that metformin use contributes to vitamin B12 deficiency in patients with type 2 diabetes mellitus (T2DM). However, there has been a lack of data assessing this issue in Jordan. Assess the vitamin B12 serum levels, frequency of vitamin B12 deficiency, and related factors among Jordanian patients with T2DM patients treated with metformin. a total of 447 subjects attending a primary health care center were included in this cross-sectional study consisting of T2DM patients who use metformin and a control group of non-diabetics. Serum B12 levels were evaluated and B12 deficiency was defined as serum B12 levels ≤ 200 pmol/L. Associations of B12 serum levels or B12 deficiency with other factors like gender, age, and duration of T2DM were analyzed. There was no significant difference in serum B12 levels nor the frequency of vitamin B12 deficiency between T2DM metformin-treated patients and control groups. Among metformin-treated patients there was no difference relating to age, type 2 diabetes mellitus duration, proton pump inhibitors use, and metformin use (duration, dose) between patients with or without B12 deficiency. The prevalence of vitamin B12 deficiency among T2DM patients on metformin treatment in this study was high (48.9%). However, the treatment with metformin and the dose of metformin use was not associated with vitamin B12 deficiency.

Bacteroides ovatus accelerates metformin-induced vitamin B12 deficiency in type 2 diabetes patients by accumulating cobalamin

Vitamin B12 (VB12) deficiency, which may lead to hematologic and neurologic symptoms, has been associated with metformin use, but the underlying mechanism is unclear. Here we report the B. ovatus as an effective VB12 catcher which was enriched in the type 2 diabetes patients suffered from VB12 deficiency after 3 to 6 months of metformin treatment. Colonization of B. ovatus increased the plasma levels of methylmalonic acid and homocysteine in high-fat diet (HFD)-fed mice treated with metformin, and compromised the efficacy of metformin against the HFD-induced metabolic disorders. Mechanistically, metformin increased the intracellular accumulation of VB12 in B. ovatus via btuB upregulation and promoted ATP production for energy-dependent translocation of VB12 transporters at the inner membrane, leading to an enhanced colonization of B. ovatus to compete for VB12 with hosts and subsequently an aggravated VB12 deficiency in the host. Our findings illustrate a previously unappreciated mechanism of metformin leads to host VB12 deficiency by acting directly on gut bacteria to increase their VB12 uptake and consumption, and suggest that inter-host-microbe competition for nutrients may broadly impact human health and drug safety.

STUDY OF VITAMIN B12 LEVELS IN PATIENT WITH TYPE 2 DIABETES MELLITUS

Aims :-Evaluation of serum Vitamin B12 levels in type 2 diabetic population. Objectives:-1) To define the prevalence of vitamin B12 deficiency in type 2 diabetic population.2) To determine the risk factors associated with Vit B12 deficiency in type 2 diabetes like Age and Metformin use.3) To Assess the co-relation of Serum B12 levels and Diabetic Retinopathy in Type II Diabetes mellitus. Material and Methods:-This case control study was conducted in OPD of Department of General Medicine, Sarvajanik Hospital, Pune between June 2012 to May 2013. A total of 50 type 2 Diabetes Mellitus patients and 50 controls between 40 to 60 years were included. Serum Vitamin B12 levels and serum homocysteine levels were measured in all patients. Results:-The Vitamin B12 deficiency was present in 56% of the diabetics and 32% of the non-diabetics. Vitamin B12 deficiency was present in 48.4% of patients who were not on metformin and 68.4% of than those were on metformin. No significant increase in the prevalence of neuropathy, anaemia, or MCV was found in the Vitamin B12 deficient patients as compared to patients with normal Conclusions:- The study has shown that the diabetes was common after the age of 40 years. Male sex, Overweight and Obesity were other risk factors. Majority of the patients in this study had the diabetes more than 5 years and their blood sugar markers were disturbed. This study has shown that the vitamin B12 deficiency was found in more than half of the diabetics, metformin users and those who were on vegetarian diet.

Deficiency of Vitamin B12 in Type 2 Diabetic Patients Receiving Metformin Therapy at HMC Hospital Peshawar

Background: Diabetes mellitus is on the rise at an alarming rate, and it has now become a global issue. Type 2 Diabetic Mellitus is a disease characterized by disturbances in glucose, protein, and fat metabolism. Diabetes has been increasingly common in recent decades, causing significant socioeconomic burden, particularly in poorer countries.&#x0D; Objective: To investigate the prevalence of vitamin B12 deficiency in Type 2 diabetes patients taking metformin.&#x0D; Methodology: This study was conducted on T2 diabetic patients in the Diabetic Department of Diabetes and Endocrinology HMC Hospital, Peshawar, for a year (10 February 2019 to 12 March 2020). The demographic data of the recruited patients was obtained after they gave their informed written consent. Patients inquired about their metformin use history, dosage, and duration of type 2 diabetes mellitus. A 5cc venous blood sample was taken from the arm and kept at 4 degrees Celsius. Vitamin B12 levels were measured using enzyme-linked immunoassay assays after serum was withdrawn. ELISA was used to determine the Vitamin B12 level in serums.&#x0D; Results: A total of 149 people were enrolled in this trial. The patients' average age was 55 years. In this study, there were 67 (38.8%) males and 82 (55.2%) females. The individuals had a 5.12-year history of diabetes mellitus. The average HbA1c level was 8.280.32. The individuals that were included have taken metformin for at least 4.8 years. There were 25 (22.6%) patients using 1000-1500 mg metformin daily, 76 (46.4%) receiving 1500-2000 mg metformin daily, and 48 (40.7%) taking greater than 2000 mg metformin daily. There were 44 patients with a normal BMI, 80 patients who were overweight, and 25 patients who were obese. The average B12 level in the blood was 223pg/ml. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. There was no vitamin B12 deficiency in 53 (45.4%) of the patients.&#x0D; 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 taking metformin, and patients should be given R.D.A (Recommended Dietary Allowance) multivitamins to avoid sequaela of cobalamin deficiency.

Frequency of Vitamin B12 Deficiency in Type 2 Diabetic Patients Taking Metformin.

IntroductionType 2 diabetes mellitus (DM) is a prevalent global health problem and is on a constant rise, especially in middle- and low-income countries. Vitamin B12 malabsorption is one of the reported side effects of metformin. Our study aims to assess the correlation of B12 deficiency in type 2 diabetics using metformin for their treatment.MethodsThis case-control study was conducted in a tertiary care hospital in Pakistan from February 2021 to December 2021. Patients (n=100) with a documented diagnosis of type 2 DM on metformin monotherapy for a minimum of six months were enrolled via consecutive convenient non-probability sampling. Another 100 patients without a history of diabetes were included in the study as a control group for comparison.ResultsSerum vitamin B-12 levels were higher in the non-diabetic participants as compared to the diabetic group (301.71 ± 72.12 vs. 189.25 ± 31.22; p-value: <0.0001). Hypovitaminosis was more significant in the diabetic group (p-value: 0.0000). Serum vitamin B12 levels were found to be declining with the increasing duration of metformin use (p-value: <0.0001).ConclusionOur study found a significant effect of vitamin B12 deficiency in metformin-treated patients. Therefore, it is prudent to recognize B12 deficiency as a potential side effect of long-term use of metformin. A periodic screening of B12 in such patients and subsequent supplementation of vitamin B12 is an effective and safe means of prevention of development or worsening of peripheral nerve damage and other clinical manifestations.

Assessment of Vitamin B12 Deficiency Caused by Metformin in Type II Diabetic Patients

Metformin use over time reduces vitamin B12 levels, according to several studies, and its clinical manifestation can be mistaken as diabetic peripheral neuropathy. In order to investigate vitamin-B12 deficiency in type II diabetic patients with long-term metformin treatment, a link between vitamin B12 and peripheral neuropathy, and to evaluate the quality of life in (T2DM) patients, the current study was done. At Sree Balaji Medical College and Hospital's outpatient and inpatient departments, a prospective observational case-control research was done. The study included 35 healthy volunteers (controls) and 35 Type 2 diabetes patients who had been on metformin for more than six months (cases). Patients' venous blood samples were collected in K2 EDTA vacutainers and centrifuged at 1500 rpm for 10 minutes, settled plasma was transferred into cryo-vials, and parameters such as Vitamin-B12, HbA1c, and CBP were estimated and this is used to conduct the statistical analysis. The prevalence of blood vitamin B12 deficiency and borderline deficiency in T2DM patients is 20.5 percent, while the mean HbA1C values in our study T2DM subjects are 9.07 percent, indicating either poor diabetes control or poor metformin drug compliance. Vitamin B12 insufficiency was found in 83 percent of T2DM patients who had been using metformin for 1 to 10 years. The reliability test was used to assess their quality of life, and the results revealed that the study participants' quality of life was poor.

Prevalence of Vitamin B12 deficiency in Type II diabetic patients using metformin.

Objectives: To determine the prevalence of Vitamin B12 deficiency in type II diabetic patients using metformin. Study Design: Cross Sectional study. Setting: Endocrinology Unit Shalamar Hospital Lahore. Period: July to September 2017. Material &amp; Methods: All of our patients were having previously diagnosed type II diabetes and using metformin for more than six months. Using strict exclusion criteria, vitamin B12 levels of patients were measured and analyzed. Results: It was evident from the present study that 27.33% of type II diabetic patients using metformin were having vitamin B12 levels less than 150pg/ml. Furthermore, our study showed that smokers are more liable to develop vitamin B12 deficiency than the nonsmokers. Also, use of multivitamins (containing vitamin B12) had a protective role against vitamin B12 deficiency. Conclusions: Long term use of metformin in type II diabetic patients is strongly associated with Vitamin B12 deficiency, therefore endocrinologists and physicians should take into consideration this significant adverse effect of metformin and screen for vitamin B12 deficiency in diabetic population before starting metformin therapy.

Vitamin B12 deficiency in patients with type 2 diabetes mellitus using metformin and the associated factors in Saudi Arabia.

Objectives:To assess the presence of vitamin B12 deficiency among metformin users and associated factors in patients with type 2 diabetes mellitus.Methods:An observational cross-sectional study was conducted with 307 diabetic patients in the primary health care centers at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia between October 2017 and January 2018. Face-to-face interviews were conducted with the participants, using a designed checklist.Results:The prevalence of vitamin B12 deficiency was (3.6%) and the majority of the sample had borderline B12 levels (66.1%). The vitamin B12 deficiency and borderline levels were strongly associated with the dose of metformin. Patients taking doses of metformin more than 1000 mg had lower levels of vitamin B12. The use of multivitamin and vitamin B complex was assessed, and it was found that there was a marked decrease in the prevalence of vitamin B12 deficiency in patients using vitamin B complex containing more than 200 mcg vitamin B12.Conclusion:Our findings show a low prevalence of vitamin B12 deficiency in type 2 diabetic patients taking metformin. The majority of the sample had borderline deficiency; therefore, additional investigation and management are required.

Prevalence of vitamin B12 deficiency in type 2 diabetes mellitus patients on metformin therapy in a tertiary care hospital

Background: The objective of the study was to estimate the prevalence of vitamin B12 deficiency and presence of peripheral neuropathy in type 2 diabetes patients on metformin treatment.Methods: This cross-sectional study was carried out in Department of Biochemistry and Medicine in a tertiary care teaching hospital in south India. Type 2 diabetes mellitus patients diagnosed based on World Health Organization (WHO) criteria treated with metformin for more than 6 months were included in the study. B12 levels were estimated and DNS scoring, vibration perception test and 10 gm Semmes-Weinstein monofilament test done.Results: A total of 55 participants were identified. Most of them were on 1500 mg of metformin once a day in divided dose. In this study maximum number of participants are in the age group of 50-70 years. Peripheral neuropathy is seen in 43.9% of persons with normal B12 levels and 28.5% of persons with low B12 levels. A Chi square test showed a chi square statistic value of 1.8221 with a p value of 0.312 which is not significant. Univariate analysis showed vitamin B12 deficient patients are of significantly higher age (63 years versus 57 years p=0.01) and with higher duration of treatment (9 years versus 6 years p=0.01).Conclusions: Prolonged metformin therapy is associated with deficiency of vitamin B12. The prevalence of B12 deficiency among diabetic patients on metformin was found to be 25.45%. Routine B12 estimation and correction of low B12 levels will be beneficial to these patients. Earlier initiation of B12 in patients on metformin may prevent the onset of neurological damage.

Prevalence of Vitamin B12 Deficiency in Type 2 Diabetes Patient Treated with Metformin

Prevalence of Vitamin B12 Deficiency in Type 2 Diabetes Patient Treated with Metformin

Vitamin B12 deficiency in type 2 diabetic patients on metformin: a cross-sectional study from South-Western part of Ghana

ABSTRACTIntroduction: Metformin is the most widely administered anti-diabetic medication among type 2 diabetes mellitus (T2DM) patients. However, metformin induces vitamin B12 malabsorption which may increase the risk of vitamin B12 deficiency among T2DM patients. We determined the prevalence of vitamin B12 deficiency and related risk factors among Ghanaian T2DM patients on metformin therapy.Methods: This cross-sectional study recruited 196 T2DM patients attending the outpatient diabetic clinic at the Effia Nkwanta Regional Hospital, Ghana. Fasting venous blood was collected for biochemical analysis. Vitamin B12 deficiency was defined as serum B12 <100 pg/ml and methylmalonic acid (MMA) ≥ 0.4µmol/L.Results: The prevalence of vitamin B12 deficiency based on serum vitamin B12, MMA, and the combination of both methods were 32.1%, 14.8%, and 14.3%, respectively. Longer duration of metformin use [5-9 years; aOR= 2.83, 95% CI (1.03-7.81), p=0.045 and ≥10 years; aOR= 4.17, 95% CI (1.41-12.33), p=0.010], higher daily dose of metformin [1000-2000 mg/day; aOR= 1.34, 95% CI (0.25-2.74), p=0.038 and >2000 mg/day; aOR= 1.13, 95% CI (0.39-2.97), p=0.047], and very high body fat [aOR= 2.98, 95% CI (1.47-6.05), p=0.020] were significantly associated with increased odds of vitamin B12 deficiency. For daily dose of metformin, a cutoff value of 1500 mg/day presented with a sensitivity, specificity, and AUC of 71.4%, 40.1%, and 0.54 (95% CI, 0.53-0.54), respectively, in predicting vitamin B12 deficiency. A ≥ six (6) years duration of metformin therapy presented with a sensitivity, specificity, and AUC of 70.4%, 62.9%, and 0.66 (95% CI, 0.57-0.75), respectively, in predicting vitamin B12 deficiency.Conclusion: Vitamin B12 deficiency is high among T2DM patients on metformin therapy in Ghana. There is the need for regular monitoring of vitamin B12 levels especially in T2DM patients on metformin daily dose of ≥ 1500 mg for duration of therapy ≥ 6 years.

There is a positive association between vitamin B12 deficiency and serum total cholesterol in Iranian type 2 diabetic patients on Metformin

Abstract Introduction Considering the low level of vitamin B12 in diabetic patients on Metformin and also the importance of this vitamin in lipid metabolism , the aim of the present study was assessing the possible relationship between vitamin B 12 deficiency, lipid profile and atherogenic indices in Iranian diabetic patients. Method In the present cross-sectional study, a sample of 200 patients with type 2 diabetes was selected. Serum level of lipid profile was measured using enzymatic colorimetric method. LDL-C was calculated by Friedewald equation and atherogenic indices including total cholesterol to HDL-C and Log Triglyceride to HDL-C ratio were calculated. Serum level of vitamin B 12 was measured photometrically using commercial kit. Results The prevalence of vitamin B12 deficiency was about 14%. There was a significant difference between normal participants and vitamin B12 deficient subjects in the case of total cholesterol (P = 0.04). The results of the regression analysis showed that in adjusted model, there was significant association between total cholesterol and vitamin B12 deficiency (OR: 16.46 [95% CI: 0.27, 33.19], P = 0.04). Conclusion The results of the present study showed the relatively high prevalence of the vitamin B12 deficiency in type 2 diabetic patients who were on Metformin. Moreover, there was a significant association between vitamin B12 deficiency and total cholesterol level in diabetic patients. Further studies with larger sample size and considering dietary information and duration of Metformin consumption are needed to confirm these preliminary results.

The study of association of Vitamin B12 deficiency in type 2 diabetes mellitus with and without diabetic nephropathy in North Indian Population

AimDiabetic Mellitus is the chronic metabolic disorder associated with various complications of heart, eyes, nerves, kidney etc. Diabetic Nephropathy is one of the leading causes of death in diabetic patient. We hypothesized that decrease Vitamin B12 levels is associated with Diabetic Nephropathy. Aim of our study is to study the serum Vitamin B12 levels in type 2 diabetes mellitus patients with and without nephropathy. MethodsOur study population consist of 100 subjects out of which 50 cases of Diabetes Mellitus without Diabetic Nephropathy and 50 cases of Diabetes Mellitus with Diabetic Nephropathy. We measured various routine lab parameters, apart from it, we measured spot urinary albumin to creatinine ratio to assess diabetic nephropathy and in special investigation we measured serum Vitamin B12 by chemiluminesence based immunoassay. ResultSerum Vitamin B12 level in the group with nephropathy (181.6±17.6pg/dl) was significantly lower than in the group without nephropathy (286±30.1pg/dl) (p=0.03). ConclusionOur study points towards the decrease levels of serum Vitamin B12 levels associated with the complication of diabetic mellitus such as diabetic nephropathy. So treatment of Vitamin B12 deficiency by supplementing could prevent the development and progression of diabetic nephropathy and improves the overall management of diabetic patient.

Vitamin B12 Deficiency in Diabetic Patients on Chronic Metformin Therapy

Introduction: Since its approval and universal acknowledgement in the 1990's as a first line agent for the treatment of Diabetes Mellitus Type II, studies have shown vitamin B12 deficiency to be a complication of chronic metformin therapy. Despite this awareness and few studies aimed at the general population, a systematic assessment of the prevalence of vitamin B12 deficiency in Type II diabetics on metformin in the veteran population has not been performed. Methods: A retrospective data analysis at a VA Hospital from 2002-2012 was performed which included 3844 diabetic patients on metformin who had B12 levels drawn while on metformin. Vitamin B12 deficiency was defined as B12 ≤ 218 pg/mL and further subdivided into moderate (218-175 pg/mL) and severe (1500 mg/day). The duration of metformin therapy was categorized as short (4 years) and long (>4 years). Results: Overall prevalence of B12 deficiency while on metformin therapy was 9.8 %. Only 38 % of the patients had baseline B12 levels checked prior to their becoming deficient. There was a significant difference when comparing B12 deficiency between control vs. metformin group (P < 0.0001 CI (2.5-10.6), OR 5.1, and Metformin vs. Insulin group P < 0.0001, CI (0.13-1.43), OR 11.6 (Table 1). There was a significant difference between short duration vs. long duration of metformin in regards to moderate vs. severe B12 deficiency (Table 2). In addition, there was a significant difference between low dose metformin group and high dose metformin group in regards to moderate vs. severe B12 deficiency (Table 2).Table 1: P value, Confidence Interval, and OR for Control vs. Metformin vs. Insulin.Table 2: Comparison of Duration and Dosing of Metformin therapy vs. B12 deficiencyConclusion: We report 9.8% overall prevalence of patients with B12 deficiency while on metformin. Compared to insulin-treated diabetics and non-diabetics, metformin group had significantly more patients with overt B12 deficiency (B12 < 218 pg/mL). Higher dose and longer duration appear to worsen the problem. B12 deficiency develops gradually and is frequently overlooked although it is easy to treat if suspected and managed in time. Our study highlights the lack of awareness of this important problem as evidenced by the small percentage of veterans that had undergone prior B12 testing (38%). Primary care providers and specialists need to be cognizant of the necessity of Vitamin B12 testing with chronic metformin therapy.

Vitamin B12 deficiency is associated with adverse lipid profile in Europeans and Indians with type 2 diabetes.

BackgroundMetformin, a standard therapy in type 2 diabetes, reduces vitamin B12 levels. Studies linking low vitamin B12 levels and cardiovascular disease are equivocal and suggest improving B12 levels may help in primary prevention. The role of vitamin B12 deficiency on cardiovascular risk factors, especially in type 2 diabetes has not been explored. The aim of this study is to investigate whether vitamin B12 deficiency in type 2 diabetes patients is associated with cardiovascular risk factors in two different ethnic groups in UK and India.MethodsType 2 diabetes patients from two secondary care diabetic centres (Europeans - UK and Indians - India) were studied. Serum vitamin B12, folate and biochemical parameters were measured.ResultsThe prevalence rates of vitamin B12 deficiency (<191 ng/L) were 27% and 12% in Europeans and Indians, respectively and higher in metformin treated type 2 diabetes patients. In linear regression analysis, after adjusting for all likely confounding factors, vitamin B12 independently associated with triglycerides in both the populations and cholesterol/HDL ratio in Indians. Logistic regression showed type 2 diabetes patients with vitamin B12 deficiency were at significantly higher odds of having coexisting coronary artery disease (CAD) in Europeans with similar but non-significant trend in Indians, after adjusting for all likely confounding factors.ConclusionsThe prevalence of vitamin B12 deficiency is common in type 2 diabetes patients and is associated with adverse lipid parameters. Type 2 diabetes management guidelines should include the recommendation for regular testing for B12 levels, especially for those on metformin.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-014-0129-4) contains supplementary material, which is available to authorized users.