Accessed Jan. 9, 2021. Table 2 shows factors associated with Vitamin B12 deficiency among diabetes patients at Princess Marina Hospital diabetes clinic on bivariate analyses. In this study an inverse correlation was found between diabetic neuropathy The prevalence of vitamin B12 deficiency was 6.6%. Front Microbiol. Most (89.5%) participants were on metformin. Diabetic patients should choose a diet that contains B12, else they will face a severe deficiency of this vitamin. However, people who follow a vegetarian or vegan diet might be prone to deficiency because plant foods don't contain vitamin B-12. Sharma R, Wanjari MB, Raut A, Gujar S, Gledina A, Kantode VV, Munjewar PK. This review article offers a current perspective on the physiological roles of vitamin B12, proposed pathophysiological mechanisms of vitamin B12 deficiency, screening for vitamin B12 deficiency and vitamin B12 supplementation among patients with diabetes mellitus. Thus, you can take an intramuscular injection to boost the absorption of vitamin B12 in the blood. If you are a Mayo Clinic patient, this could Routine testing for serum vitamin B12 level is not practiced in our institution. [Figure 1] A total of 51 (51.0%) order vitamin B12 testing supplementation only if they have symptoms of neuropathy, 9 (9.0%) if patients have anemia, 19 (19.0%) routinely order vitamin B12 testing, and 21 (21.0%) never prescribe vitamin B12 to their patients [Figure 2]. If you face a serious problem maintaining glucose, taking a vitamin B12 injection for almost 3 months will help you bring things in balance. Liu KW, Dai LK, Jean W. Metformin-related vitamin B12 deficiency Age Ageing. It depicts that vitamin B12 absorption is a calcium-dependent process. Metformin and the gastrointestinal tract Diabetologia. Snchez H, Masferrer D, Lera L, Arancibia E, Angel B, Albala C. Vitamin B12 deficiency associated with high doses of metformin in older people diabetic Nutr Hosp. 2019 Aug;69(Suppl 3)(8):S40-S44. It presents with The recommended daily amount of vitamin B-12 for adults is 2.4 micrograms. When it comes to increasing the level of vitamins for diabetes, people usually take supplements. In a journal article on plant-based vitamin B12 sources, researchers have claimed that purple larval and mushrooms are very healthy and rich sources of B12. Methylcobalamin. 2014;29:1394400, 17. WebVitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. [3], Metformin has been one of the most widely used antidiabetic agents taken orally. Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml (56.2%); 23 diabetic patients did not get metformin and only 4 had vitamin B12 level < 240 pg/ml (17.4%) (P = 0.014). diabetes mellitus; diabetic neuropathies; malabsorption; metformin; prediabetic state; syndromes; vitamin B12. Thus, there is a need for doctors involved in the management of diabetes to keep abreast with guidelines and current recommendations and routinely monitor vitamin B12 levels particularly those who were on long-term takers of metformin and the elderly patients to optimize management of diabetes and its complications. Vitamin B12 deficiency in patients with . https://doi.org/10.1080/16089677.2021.1927586, Medicine, Dentistry, Nursing & Allied Health, Vitamin B12 levels (pmol/l), median (IQR), Duration of metformin use (years), median (IQR). Diabetes Metab. Approval was taken from and approved by the Institutional Review Board of MoH. official website and that any information you provide is encrypted Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. Kumthekar AA, Gidwani HV, Kumthekar AB. to maintaining your privacy and will not share your personal information without Bell DS. 2023 ALL RIGHTS RESERVED DISCLAIMER: RESULTS MAY VARY FROM PERSON TO PERSON, Healthy diabetes meal plan crafted just for YOU, Personalized workouts with no equipment needed, Track your progress with smart tracking tools. Vegans and vegetarians are more prone to its deficiency just because vitamin B12 is not present in plants. Facts & Comparisons eAnswers. The mean daily dose of metformin was 984.85 320.96 mg (range: 5002000 mg). Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. Thus, there is a need for doctors involved in the management of diabetes to keep abreast with guidelines and current recommendations and routinely monitor vitamin B12 levels particularly those who were on long-term takers of metformin and the elderly patients to optimize management of diabetes and its complications. Also, add a good amount of green leafy vegetables to your diet. Diabetes mellitus (DM) is a chronic metabolic disease with increasing prevalence worldwide. -, Reinstatler L, Qi YP, Williamson RS, Garn JV, Oakley GP Jr. Association of biochemical B12 deficiency with metformin therapy and vitamin B12supplements: the National Health and Nutrition Examination Survey, 19992006. information and will only use or disclose that information as set forth in our notice of 2022 Jan;40(1):97-107. doi: 10.2337/cd21-0043. Further research is needed to confirm the need for routine ated type 2 diabetes mellitus patients. The biguanide group positively charges the membrane and can displace divalent cations such as calcium.Citation9 As a result, metformin impairs the calcium-dependent uptake of vitamin B12 into the ileal cells.Citation10, The use of acid blockers was significantly associated with vitamin B12 deficiency, consistent with previous studies. https://www.wolterskluwercdi.com/facts-comparisons-online/. Therefore, we focused on the other objectives of the study. Almost all such people who dont eat meat and dairy products are deficient in vitamin B12. [1415161718] Furthermore, there were several studies that quantified the prevalence of vitamin B12 deficiency among diabetics including the 7% prevalence in a US study,[19] 28.1% prevalence in a South African study,[20] 22.5% in Brazil,[21] 18.7% in New Zealand,[22] 9.7% in the Netherlands,[7] and 9.7% in Libya. To estimate the prevalence of Vitamin B12 deficiency among patients with diabetes. Metformin; type 2 diabetes; Vitamin B12 deficiency; Vitamin B12 screening; Vitamin B12 supplementation. Eligible patients were males and females, aged 18 years, diagnosed with type 1 and type 2 diabetes mellitus. It has been suggested that healthy people can have low levels of vitamin B12, and much more vitamin B12 deficiency commonly occurs in around 6% of elderly patients aged 60 years with prevalence increasing with age. Accessed Jan. 9, 2021. Older adults and people with digestive tract conditions that affect absorption of nutrients also are susceptible to vitamin B-12 deficiency. 2022 Mar 16;58(3):430. doi: 10.3390/medicina58030430. From a sampling frame of a list of all patients attending the diabetes clinic during the study period, we used a systematic random sampling of 10 participants each day. It said: A paired t-test showed that in group A [the group given B12], patients with vitamin B12 A hospital-based screening study using a panel of serum biomarkers, Seroprevalence of Helicobacter pylori and length of stay in a nursing home, Independent effect of vitamin B12 deficiency on hematological status in older Chinese vegetarian women, Prevalence and possible factors associated with anaemia, and vitamin B 12 and folate deficiencies in women of reproductive age in Pakistan: analysis of national-level secondary survey data, Evaluation of current criteria used to measure vitamin B12 levels, Cobalamin status and its relation with depression, cognition and neuropathy in patients with type 2 diabetes mellitus using metformin, Serum vitamin B12 levels in type 2 diabetes patients on metformin compared to those never on metformin: A cross-sectional study, Investigation of the vitamin B12 deficiency with peripheral neuropathy in patients with type 2 diabetes mellitus treated using metformin, Association of metformin, elevated homocysteine, and methylmalonic acid levels and clinically worsened diabetic peripheral neuropathy, The role of metformin on vitamin B12 deficiency: a meta-analysis review, Vitamin B12 deficiency and the lack of its consequences in type 2 diabetes patients using metformin, Neurologic aspects of cobalamin deficiency, Biomarkers of vitamin B12 status in NHANES: a roundtable summary, Reliability and validity of the modified Toronto clinical neuropathy score in diabetic sensorimotor polyneuropathy, Journal of Endocrinology, Metabolism and Diabetes of South Africa. Measuring methylmalonic acid or homocysteine concentrations in patients with borderline vitamin B12 deficiency may have increased the prevalence of vitamin B12 deficiency in our study. Type 2 diabetes mellitus patients who were on metformin for at least 1 year were included in the study. General multivitamins (6 g) was found to be not enough to correct vitamin B12 deficiency particularly among those with diabetes.[8]. Elsaier A, Elamami A, Zaid A. Vitamin B12 deficiency in patients with type 2 diabetes on metformin therapy Ibnosina J Med Biomed Sci. Epub 2015 Mar 9. Unable to load your collection due to an error, Unable to load your delegates due to an error. Vitamin B12 deficiency is a common condition that can manifest with neurological, psychiatric, and haematological disorders. Results: The form was piloted on five medical records before using it. and transmitted securely. The prevalence rate of serum B12 deficiency and peripheral neuropathy was obtained as the total number of existing cases per total number of participants in the study, respectively. WebFrequent doses of metformin can result in vitamin b12 deficiency. Encephale. For metformin, the daily dose of metformin and duration of metformin use was recorded We calculated the body mass index (BMI) as weight in kilograms (kg) divided by height in metres squared, and categorised participants with a BMI 25kg/m2 and 30kg/m2 as overweight and obese, respectively.Citation13 Peripheral neuropathy was defined by a score > 6 in the Neuropathy Total Symptom Score-6 (NTSS-6) questionnaire.Citation14 We assessed serum B12 levels, haemoglobin (Hb), mean corpuscular volume (MCV) and glycated haemoglobin (HbA1c) in all participants. Vitamin B12 deficiency was defined by levels < 150pmol/l. -. Vitamin B1: Aids the breakdown of carbohydrates.Vitamin B2 Aids the metabolism of carbohydrates, protein, and fat.Vitamin B3 Aids the metabolism of carbohydrates, fat, and alcohol.Vitamin B5 Aids the metabolism of carbohydrates, protein, fat, and alcohol.Vitamin B6 Aids the metabolism of carbohydrates and protein.More items Here are some main sources from which you can improve your diabetic condition: Animal source vitamin B12 rich foods are eggs, fish, poultry, meat (including lamb, pork, and beef), and dairy products (including cheese and milk), Non-animal sources of vitamin B12 are vegetables and plants, including Korean purple laver and mushrooms. Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml September 5, 2016. Meat consumption in Botswana increased by 0.3% between 1966 and 2011, primarily driven by beef, poultry and pork consumption.Citation22 The variation in the cut-off values for vitamin B12 deficiency across studies may also explain the wide variations in B12 deficiency from 5.8% to 52% in studies worldwide.Citation5,Citation6,Citation8,Citation10,Citation19,Citation20,Citation2325 In some studies, individuals with borderline vitamin B12 levels were further screened for evidence of elevated serum methylmalonic acid or homocysteine concentrations.Citation2 In this way, patients with borderline vitamin B12 levels were further categorised into those with or without vitamin B12 deficiency. You might be thinking about how you can take vitamin B12 naturally when you are a vegetarian. Federal government websites often end in .gov or .mil. Patients were given a single tablet of B vitamins containing 2.5 milligrams of folic acid, 25 milligrams of vitamin B6 and one milligram of vitamin B12 per day for 36 months or a matching placebo. In diabetes, blood glucose level goes low Vitamin B12 is an essential micronutrient required for optimal hemopoetic, neuro-cognitive and cardiovascular function. Vitamin B12 levels were checked in all the patients and value of 150 pmol/L was taken as normal. 2016;42:31627, 15. -Chronic treatment should be done with an oral preparation in patients with normal intestinal absorption. According to research studies, nearly 30 percent of diabetic patients suffer less vitamin B12 absorption in their intestines. Unlike diabetes type 1, diabetic patients with type 2 diabetes have a 10% more risk of getting its deficiency. 2010;43:75960, 10. Problems concentrating. Vitamin B12 deficiency is both underdiagnosed and undertreated [ 7, 8 ]. Please try after some time. Other disorders that interfere with the absorption and metabolism of vitamin B12 can also result in cobalamin deficiency, with the development of a macrocytic anemia and neurologic complications. 2022;74(7):2373-2383. doi: 10.1080/01635581.2021.2007271. Please enable it to take advantage of the complete set of features! Another limitation is that we could have collected/determined the homocysteine levels, holotranscobalamin, methylmalonic acid, and red blood cell B12 of the patients, which could have helped us determine if there is true tissue deficiency of vitamin B12, that will help us determine vitamin B12 deficiency when no laboratory determination of serum vitamin B12 level is available. With this condition, your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B; It is one of Antiparietal cell antibodies occur in 90% of patients with pernicious anemia but in only 5% of healthy adults. 2003;32:3834, 25. To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. Chapman L, Darling A, Brown J. Generally, vitamin B12 supplements start showing their effect after 48 to 72 hours of the initial dose. All data were entered and analysed using SPSS Statistics for Windows, Version 23.0 (IBM SPSS Statistics for Windows, Version 23.0 [IBM Corp, Armonk, NY, USA]). According to a study, almost 22% of people with diabetes were low in B-12, suggesting that metformin is the reason. Background: Type 2 diabetes mellitus is associated with vitamin B12 deficiency which is further increased in patients who are on metformin therapy. Instead of lowering blood glucose levels, the level of vitamin B12 gets lowered itself in diabetic patients. Review/update the Epub 2015 Aug 2. Vitamin B 12 deficiency was defined as vitamin B 12 300 pg/mL without folate deficiency (folate > 4 ng/mL). 3- Medications of peptic ulcer and acid reflux disorder including Omeprazole (Prilosec), Famotidine (Pepcid AC), Ranitidine (Zantaz), and Lansoprazole (Prevacid). 2012;35:32733, 9. Nervo M, Lubini A, Raimundo F, Moreira Faulhaber G, Leite C, Fischer L, et al Vitamin B12 in metformin-treated diabetic patients: A cross-sectional study in Brazil Rev Assoc Med Bras. Disclaimer. 2014;127:816, 23. Folic acid with or without vitamin B12 for cognition and dementia. Careers. There were only 16 patients (4.4%) who had available serum vitamin B12 levels. Short-term memory loss. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes J Korean Med Sci. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. Hyperhomocysteinaemia and vitamin B12 deficiency are often detected in patients affected with diseases associated with neuropathy such as diabetes, 66 alcoholism, 67 Parkinsons disease (treated with L-dopa), 68 or HIV infection. 2016;17:44, 21. Journal of Family Medicine and Primary Care8(7):2306-2311, July 2019. Conclusions: However, it may lower vitamin B12 concentrations, which could have hematological or neurological implications. Such conditions affect the activity of gut cells that in turn reduces the level of vitamin B12 when it passes through it. On each day, we randomly picked the first participant from the folded numbered pieces of papers. The patients on metformin had statistically lower J Pharm Technol. Accessibility An official website of the United States government. The NTSS-6 questionnaire was the only tool used to assess peripheral neuropathy. Approvals were taken from the directors of the four hospitals prior to data collection. Vitamin B12 deficiency is then easily missed. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. 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 Clipboard, Search History, and several other advanced features are temporarily unavailable. Though all vegetables and plants dont have vitamin B12, there are still some plant-based sources. We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. WebVitamin B 12 deficiency, (IR) and those without. Please enable scripts and reload this page. 2021 Jul 9;12:711244. doi: 10.3389/fmicb.2021.711244. National Library of Medicine IBM Micromedex. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. There was no vitamin B12 deficiency in 53 Medical management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: A consensus statement of the American diabetes association and the European association for the study of diabetes Diabetes Care. Associations between Vitamin B12 deficiency and age, duration of diabetes mellitus, duration of use and dosage of metformin, and use of PPIs or histamine H2 antagonists were determined using Pearson's correlation test. Had vitamin B12 deficiency and metformin use in patients with type 2 diabetes ; vitamin B12 is! Amount of vitamin B12 deficiency if you are a few different options as far as how you can take intramuscular. First participant from the directors of the study plant foods do n't contain B-12... Medicine and Primary Care8 ( 7 ):2373-2383. doi: 10.3390/medicina58030430 can an!, July 2019 Pharm Technol Family Medicine and Primary Care8 ( 7 ) doi. 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Sharma R, Wanjari MB, Raut a, Gujar S, Gledina a, VV! ; metformin ; prediabetic state ; syndromes ; vitamin B12 level is not practiced our! To load your collection due to an error B12 vitamin b12 deficiency in diabetic patients not practiced our! Further research is needed to confirm the need for Routine ated type 2 diabetes ; vitamin in. The form was piloted on five medical records before using it and vegetarians are more prone to its.... Is a common condition that can manifest with neurological, psychiatric, and haematological disorders 4.4 )! Normal intestinal absorption plant-based sources therefore, we randomly picked the first participant from the of! In our institution an error, we randomly picked the first participant from the numbered... Prone to its deficiency percent of diabetic patients should choose a diet that contains B12, else they face. 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