Should people treated with metformin be screened for vitamin b. Vitamin b12 deficiency in diabetic patients on metformin. This case illustrates an 87 yearold previouslyindependent man presenting with progressive gait unsteadiness over one week assistance of two for transfers and ascending numbness of the feet like walking on ice. Pdf vitamin b12, also known as cobalamin, is a watersoluble vitamin essential for hematopoietic and neurological functions in the body. Metformin, one of the most commonly used drugs to treat diabetes, may be causing vitamin b12 and folate deficiencies in those that take the drug. Long term treatment with metformin in patients with type 2. When a nutrient is essential, it means the body cannot produce it internally so it must come from food we eat or supplemental form. Large amounts of folic acid can hide a vitamin b12 deficiency by correcting megaloblastic anemia, a hallmark of vitamin b12 deficiency. Metformin and vitamin b12 deficiency endocrinology jama. Metformin causing vitamin b12 deficiency diabetes care.
In infants, signs of a vitamin b12 deficiency include failure to thrive, problems with movement, delays in reaching the typical developmental milestones, and megaloblastic anemia. The possibility to measure holotranscobalamin active b12 and the metabolic marker, methylmalonic acid mma, has changed the practice of diagnosing b12 deficiency in recent years. This crosssectional study included 1111 patients with type 2 diabetes who took metformin for at least 6 months. Design multicentre randomised placebo controlled trial. Objectives to study the effects of metformin on the incidence of vitamin b12 deficiency 0.
If you have type 2 diabetes, you could be at higher risk of a vitamin b12 deficiency. He had a vegetarian diet and past medical history was notable for eight years of type 2 diabetes mellitus on. The prevalence of vitamin b12 deficiency in metformin treated type 2 diabetes patients was 9. The prevalence of vitamin b12 deficiency observed in this study is similar to previous studies but others have reported variable rates. The mechanism by which metformin causes vitamin b 12 deficiency is also not well established. The human body doesnt manufacture vitamin b12, so people need to get it from animal sources or from supplements. These two patients had b12 deficiency associated with metformin therapy. Metformin was stopped, diabetes was stabilised on sulfonylurea and insulin, and she was given vitamin b12 mg on alternate days for five doses followed by vitamin b12 mg on a monthly basis.
Metformin use and vitamin b12 deficiency the american journal. It is uncommon for people to have vitamin b12 levels. June 8, 2009 the popular diabetes drug metformin may contribute to vitamin b12 deficiency, according to a new study researchers found that 40% of type 2. Methods in this retrospective study, we recruited 412 individuals with t2dm. Vitamin b12, also known as cobalamin, is a watersoluble essential nutrient required in our diet. Metformin use and advanced age are associated with vitamin b12 deficiency and often present in type 2 diabetic patients, yet the prevalence of vitamin b12 deficiency in the diabetic population is unknown. Metformin has stood up well in clinical trials, showing its potential to reduce the risk of macrovascular disease a disease of the large blood vessels including those found near the heart, the brain. The american diabetes association ada has recently recommended periodic measurement of b12 levels for all patients on metformin. The prevalence of vitamin b12 deficiency in patients with. Longterm metformin use and vitamin b12 deficiency in the diabetes prevention program outcomes study.
Vitamin b12 fact sheet for consumers nih office of. Metformin interferes with vitamin b12 absorption and metabolism. Jun 05, 2018 people with diabetes may be more prone to vitamin b12 deficiency. Participants with type 2 diabetes receiving insulin therapy were randomised to receive, in addition, either.
Discovering metformininduced vitamin b12 deficiency in pati. The authors of the study advocate consideration of vitamin b12 deficiency screening for people who take metformin. Compared with placebo, patients taking metformin had an increased risk of vitamin. Metformininduced vitamin b12 deficiency presenting as a. Older patients, patients in long term treatment with metformin and low vitamin b12 intake are probably more prone to this deficiency. Methylmalonic acid and homocysteine were obtained for patients when vitamin b12 levels were found to be borderline or low. However, many aspects of the topic remain to be elucidated. The association of metformin use with vitamin b12 deficiency. Vitamin b12 is found naturally only in animal foods meat, fish, dairy. Metformin triggers a drop in b12, folate levels in diabetes. Although metformin is the preferred initial pharmacological choice in type 2 diabetes, there is evidence that reveals a link between metformin use and vitamin b12 deficiency. Metformin has been available in the united states for approximately fifteen years.
Background metformin is one of the most commonly used medications for the treatment of type 2 diabetes mellitus. The association between the biguanide drug metformin and vitamin b12 deficiency in diabetic patients. Aims to compare the prevalence of vitamin b12 deficiency and peripheral neuropathy between two groups of type 2 diabetes mellitus t2dm patients treated with or without metformin, and to determine factors associated with vitamin b12 deficiency therapy and dietary intake of vitamin b12. Jill crandall, md, professor of medicine at albert einstein college of medicine in new york, shares insights about metformin and vitamin b12. Metformin is first line of treatment in type 2 diabetes mellitus t2dm. Apr 25, 2018 providers need to be aware of the possibility of b12 deficiency and monitor patients. I really want to hone in on metformins effect of vitamin b12 levels as this could be affecting you right now. It is estimated that 10% to 30% of patients undergoing metformin therapy develop evidence of vitamin b 12 deficiency. Because metformin is first line therapy for type 2 diabetes, clinical decision support should be considered to promote serum b12 monitoring among long. Setting outpatient clinics of three nonacademic hospitals in the. Thirtyeight percent of the placebo group and 45% of the metformin group that were b12 deficient at 5 years remained deficient at years.
The association of metformin use with vitamin b12 deficiency and. The low down on metformin and vitamin b12 deficiency pcos. Well, it is good although there are some nasty side effects. Metformin use led to significantly lowered vitamin b 12 concentrations and significantly higher risk of vitamin b 12 deficiency in diabetic patients. The newest research claim that, to be free to get a vitamin b12 deficiency, you shod take, together with metformin, a tablets with calcium. Relationship between metformin use, vitamin b12 deficiency. Metformin can cause serum vitamin b12 deficiency, but studies on the influence of its duration and dose are lacking. Patients using metformin for three or more years had a lower ratio of 2.
Interestingly, they have categorically stated that. Dec 27, 20 metformin, one of the most commonly used drugs to treat diabetes, may be causing vitamin b12 and folate deficiencies in those that take the drug. Common vitamins and supplements to treat metforminrelated. I can not find that in the pharmacology literature, but the recommendation do not hurt you and probably will help. An increased risk for b12 deficiency was linked to years of metformin use or for b12 deficiencyyear metformin. Associations between metformin use and vitamin b12 levels. Association between metformin dose and vitamin b12. The question can come up whether the risk of vitamin b12 deficiency might be a factor in the decision to actually prescribe metformin. It is now believed that measuring the serum levels of the vitamin may not reflect its metabolic status. This led to improvements in gait, lower limb power, mmse 2030 and haematological abnormalities.
Pdf metformin causing vitamin b12 b12 deficiency has become a traditional myth in medical literature 1, 2. A total of 14 cases did not report a definitive cause of b12 deficiency. However, we feel that in both the patients described in their report, there are alternative causes for the deficiency of vitamin b12, which has not been. The odds ratio for serum vitamin b12 deficiency in metformin users was. Vitamin b12 deficiency, which may present without anemia and as a peripheral neuropathy, is often misdiagnosed as diabetic neuropathy, although the. Nov 03, 2017 a vitamin b12 deficiency can lead to irreversible nerve damage and even impaired cognition or dementia. The clinical manifestations of vitamin b12 deficiency fig 2,3 5 7 9 represent the effects of depletion on multiple systems and vary greatly in severity. Discovering metformininduced vitamin b12 deficiency in. Megaloblastic anaemia due to metformin associated vitamin b12 deficiency has been reported,but it can be treated successfully.
Nutritional b12 deficiency has been attributed to cases. The finding, she adds, has implications for the consequences of b12 deficiency. We report a case of vitamin b12 deficiency in a patient on metformin. Symptoms of b12 deficiency include diarrhea which is also the most common side effect of metformin, constipation, exhaustion, loss of appetite, pale skin, inflamed red tongue, and bleeding gums.
A vitamin b12 deficiency can lead to irreversible nerve damage and even impaired cognition or dementia. The time it takes to develop b 12 deficiency while taking metformin, given a reasonable dietary intake, has been estimated at 10 to 15 years. Metformin use and vitamin b deficiency in patients with type2. The results of the study indicated that each 1 g daily of metformin caused a ratio of 2. Vitamin b12 is a watersoluble vitamin that is naturally present in some foods, added to others, and available as a dietary supplement and a prescription medication. Feb 17, 2016 in infants, signs of a vitamin b12 deficiency include failure to thrive, problems with movement, delays in reaching the typical developmental milestones, and megaloblastic anemia. Medical record data collected for the preintervention period.
Megaloblastic anaemia due to metforminassociated vitamin b12 deficiency has been reported,but it can be treated successfully. Metforminrelated vitamin b12 deficiency age and ageing. Biochemical and clinical vitamin b12 deficiency has been demonstrated to be highly prevalent among diabetes mellitus type 2 patients on metformin. Vitamin b12 exists in several forms and contains the mineral cobalt 14, so compounds with vitamin b12 activity are collectively called cobalamins. Association between metformin and vitamin b12 deficiency in patients with type 2 diabetes. May 20, 2010 objectives to study the effects of metformin on the incidence of vitamin b12 deficiency vitamin b12 150220 pmoll, and folate and homocysteine concentrations in patients with type 2 diabetes receiving treatment with insulin. The purpose of this study is to define the prevalence of vitamin b12 deficiency in a type 2 diabetic population within a primary care practice. We investigated vitamin b12 deficiency in patients with type 2 diabetes using metformin, in conjunction with other related factors method. The american diabetes association ada has recently recommended periodic measurement of b12 levels for all patients on metformin local problem. Metformin treatment, both duration and dose, is associat ed with increased risk of vitamin b12 b12 deficiency. There is the need for regular monitoring of vitamin b12 levels especially in t2dm. People who do not eat animal foods can get vitamin b12 from foods fortified with this vitamin, such as fortified rice or soy milk or some cereals.
Association of biochemical b12 deficiency with metformin. Longterm metformin use linked with vitamin b12 deficiency. Below is a list of common natural remedies used to treat or reduce the symptoms of metformin related vitamin b12 deficiency. Metformin and risk for vitamin b12 deficiency diabetes self. These can include cognitive impairment, nerve problems neuropathy and anemia low red blood cell count. Association between metformin dose and vitamin b12 deficienc. However, a vitamin b12 deficiency is very serious and can lead to permanent brain and nerve damage given the role that it plays in brain and nerve health.
Vitamin b12 deficiency is common and can present itself in various ways, making it difficult to identify. Potential side effects of metformin include diarrhea, lactic acidosis, and, less commonly reported, vitamin b12 deficiency. There is a small but significant risk of developing vitamin b12 deficiency when people take metformin. More quality studies are needed to explore the associations between metformin use and anemia and neuropathy in these patients. An increased risk for b12 deficiency was linked to years of metformin use or for b12 deficiency year metformin. What are the clinical features of vitamin b 12 deficiency. Metformin and vitamin b12 deficiency endocrinology. Exhaustion of vitamin b12 stores usually occurs after twelve to fifteen years of absolute vitamin b12 deficiency. The prevalence of biochemical b 12 deficiency was 4. Providers need to be aware of the possibility of b12 deficiency and monitor patients. Long term metformin use association with vitamin b12 deficiency. Metformin triggers a drop in b12, folate levels in.
Metformin causing vitamin b12 b12 deficiency has become a traditional myth in medical literature 1,2. To learn more about metformin and diabetes, check out blog posts. If youre at risk and have any of the symptoms above, speak to your doctor. Vitamin b12 for diabetes patients treated with metformin clinmed. While this screening isnt routine, its worth it to have a talk with your healthcare provider to see if youre at risk for deficiency, especially if youve been taking metformin for several years or take a high dose. Vitamin b12 deficiency was most prevalent among the metformin group and increased over time. Jun 02, 2016 the newest research claim that, to be free to get a vitamin b12 deficiency, you shod take, together with metformin, a tablets with calcium.
Follow the links to read common uses, side effects, dosage details and. The study had 155 participants who suffered from vitamin b12 deficiency resulting from metformin use. The prevalence of vitamin b12 deficiency in metformintreated type 2 diabetes patients was 9. B12 weekly consumption and level of serum b12 n 412.
The association between metformin use and low vitamin b12 levels in type 2 diabetes mellitus patients is wellestablished. People with diabetes may be more prone to vitamin b12 deficiency. It has been reported to be associated with vitamin b12 deficiency with variable results in various studies. A full discussion on metformin is not going to be dealt with now, though. Should this be a reason to avoid prescribing metformin, especially these days when there are many other oral medications or easily administered medications that we could choose from. Objective to describe the prevalence of biochemical b12 deficiency in adults with type 2 diabetes taking metformin compared with those not taking metformin and those without diabetes, and explore whether this relationship is modified by vitamin b12 supplements. And 77% of metformin users with vitamin b12 deficiency also had peripheral neuropathy, a common form of nerve damage associated with type 2 diabetes. Metformin b12 deficiency diabetes forum the global. Crandall warned that the risk of a vitamin b12 deficiency should not be considered a reason to avoid taking metformin. Among those with diabetes, metformin use was associated with biochemical b 12 deficiency adjusted odds ratio 2. There is still controversy on the current diagnostic approaches to vitamin b12 deficiency.
The clinical manifesta tions are heterogeneous but can also be different depending on the degree and duration of d eficiency. Pdf vitamin b12 deficiency and metformin use researchgate. Vitamin b12 deficiency in type 2 diabetic patients on. Case presentation a 54yearold male with type 2 diabetes mellitus for 15 years was.
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