vitamin b12 deficiency in diabetic patients

Certain drugs may lead to (10.1210/jc.2015-3754) WebVitamin B-12 deficiency anemia is a condition in which your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B-12. eCollection 2021. Though vitamin B12 is commonly taken to increase energy levels, evidence showing that B12 supplements improve energy levels in people without a deficiency is lacking. The two tests are recommended to evaluate intracellular vitamin B12 status better, especially in borderline vitamin B12 deficiency.Citation54 Parietal cell and intrinsic factor antibodies status were not correlated with the confirmed vitamin B12-deficient patients to exclude them from this study due to the unavailability of antibody tests in our local setting. World J Diabetes. For one, this study was done retrospectively, thus the vitamin B12 status of the patients was all based on the medical records, and for this reason vitamin B12 levels were not available. 2014;29:1394400, 17. Approvals were taken from the directors of the four hospitals prior to data collection. 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. Delusions. Clinicodemographic profile of 363 T2DM patients on metformin use, Frequencies of daily doses of metformin, types of OHA used, PPI use, vitamin B12 supplement use, and daily doses of vitamin B12, Gender differences in the use of PPI, vitamin B12 supplements and duration of T2DM, duration and dose of metformin use, and vitamin B12 levels, The use of PPI, vitamin B12 supplements and duration of T2DM, duration and dose of metformin use, and vitamin B12 levels according to age groups, Demographic profile of 100 physicians who participated in the study on knowledge and perception about vitamin B12 screening, Knowledge of physicians about the current ADA recommendations on, Responses of 100 physicians on when do they order vitamin B12, 1. modify the keyword list to augment your search. Metformin and vitamin B12 deficiency: where do we stand? In addition, female patients had higher levels of vitamin B12 compared to men (coefficient: 49.1; CI 95%: 2.3-95). 2016;17:44, 21. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? 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). Lets read how type 1 and 2 diabetes affect the level of Vitamin B12 in your body. Vitamin B12 deficiency in diabetic people is quite common. In short, the long-term deficiency of vitamin B12 causes serious symptoms like depression, delusion, difficulty in walking, loss of mobility, seizures, and dementia. Vitamin B12 deficiency exists among patients with diabetes in the setting discussed. Cyanocobalamin. Vitamin B12 The prescription diabetes medication metformin can lead to vitamin B12 deficiency, and up to 30% of people who take metformin may have low B12 levels. American Diabetes Association. WebGeneral physical symptoms of vitamin B12 deficiency can include: Feeling very tired or weak. Accessed Jan. 9, 2021. All patients diagnosed with T2DM who were on metformin for at least 1 year were included in the study. [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]. Thats why it is said that calcium reverses the absorption of vitamin B12 and diabetes. The questionnaire contained questions on their demographic profile, knowledge and practice of screening of Vitamin B12 level. Impacts of statin and metformin on neuropathy in patients with type 2 diabetes mellitus: Korean Health Insurance data. Your body absorbs only as much as it needs, and any excess passes through your urine. In this study, we aimed to evaluate the prevalence of vitamin B12 deficiency in patients with chronic metformin use and the relationship between vitamin B12 deficiency and diabetic neuropathy. We conducted a cross-sectional study among patients attending Princess Marina diabetes clinic in Gaborone between July 2017 and October 2017. The The latter protects vitamin B12 from pancreatic digestion.Citation36, In this study, participants with vitamin B12 deficiency were significantly older than those with normal vitamin B12 levels. Though all vegetables and plants dont have vitamin B12, there are still some plant-based sources. Metformin; type 2 diabetes; Vitamin B12 deficiency; Vitamin B12 screening; Vitamin B12 supplementation. It said: A paired t-test showed that in group A [the group given B12], patients with vitamin B12 Methods: We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. Type 2 Diabetes Vitamin B12 Deficiency Hyperhomocysteinemia: Due to high cost for investigation serum homocysteine level was measured only in 6 patients and serum vitamin B12 level (cheaper test) was measured in 14 patients with prior permission from Ethics Committee. Never take a supplement or injection at your own decision. Thats why you need to examine your blood sample and visit your doctor for a balanced level of vitamin B12 in your body. Chapman L, Darling A, Brown J. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. Moreover, the risk of vitamin B12 deficiency also increases with increased metformin dose and duration of its use. PMC Leung S, Mattman A, Snyder F, Kassam R, Meneilly G, Nexo E. Metformin induces reductions in plasma cobalamin and haptocorrin bound cobalamin levels in elderly diabetic patients Clin Biochem. Vitamin B12 levels were checked in all the patients and value of 150 pmol/L was taken as normal. eCollection 2019. 2017Last accessed on 2019 Jan 28 Available from: 3. Common causes of vitamin B12 deficiency include infections, malabsorption, medical conditions (Crohns disease, pernicious anaemia), gastric resection, and Despite its effectiveness, you should consult your doctor after a couple of months for proper screening. Using an assumed proportion of 9.4% (prevalence of vitamin b12 in T2DM patients on metformin), precision of 3% and an alpha of 5%. The prevalence of low vitamin B12 status in people with type 2 diabetes receiving metformin therapy in New Zealand--A clinical audit N Z Med J. The tool is prone to subjectivity as it is symptom dependent, and there is a possibility of misclassification of participants. -, Aroda VR, Edelstein SL, Goldberg RB, Knowler WC, Marcovina SM, Orchard TJ, Bray GA, Schade DS, Temprosa MG, White NH, et al. MeSH (10.1007/bf00427979) These symptoms are pain and numbness in the arms, legs, hands, and feet. 2- Metformin containing Glumetza and Glucophage for treatment of diabetes type 2. 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. privacy practices. Vegans and vegetarians are more prone to its deficiency just because vitamin B12 is not present in plants. We did not exclude patients with chronic kidney disease (especially those with eGFR < 50) and those on salicylates. Even though vitamin B-12 is safe if you take too much, it can interact negatively with certain medications. Chloramphenicol, a type of antibiotic, affects how your body responds to B-12. Even though you're taking a large dose of B-12, the medication limits the vitamin's function. Of all the patients 17 were already considered to be deficient in B12. Endocrinol. Well, you can fulfill vitamin B12 intake through energy bars and breakfasts having fortified B12. According to research studies, nearly 30 percent of diabetic patients suffer less vitamin B12 absorption in their intestines. [28] Type 2 diabetics particularly those on metformin are at risk for metabolically lower levels of vitamin B12. [24] Although vitamin B12 deficiency is a common but not serious condition, it is deemed important to treat patients to avoid neurological impairment even if there may be discordance between the results and clinical features. [4] Both American and European guidelines recommend metformin as the first-line agent for the pharmacological management of T2DM. Metab., 101 (2016), pp. 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. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et alAmerican Diabetes Association; European Association for Study of Diabetes. 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. 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). A p-value of less than 0.05 was considered significant. and transmitted securely. 2012;122:25370, 5. Clinical Implications of the Coexistence of Anemia and Diabetes Mellitus in the Elderly Population. Russo GT, Giandalia A, Romeo EL, Scarcella C, Gambadoro N, Zingale R, Forte F, Perdichizzi G, Alibrandi A, Cucinotta D. J Endocrinol Invest. Metformin associated B12 deficiency J Assoc Physicians India. Careers. Please enable it to take advantage of the complete set of features! Vitamin B12 deficiency was found in 96 (49.1%) of the patients. Vitamin B-12 supplements also are recommended for women who are pregnant or breastfeeding exclusively and follow vegetarian or vegan diets. Vitamin B12 deficiency is both underdiagnosed and undertreated [ 7, 8 ]. The mean age of the patients was 53.72 11.31 years (ranged from 25 to 84 years old). We assessed vitamin B12 status using serum vitamin B12 levels. Please try after some time. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. J. Clin. Bethesda, MD 20894, Web Policies -Chronic treatment should be done with an oral preparation in patients with normal intestinal absorption. 1 The prevalence of vitamin B12 deficiency in diabetes mellitus Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. High doses of vitamin B-12, such as those used to treat a deficiency, might cause: Your doctor might recommend changing drugs or timing doses to offset any potential interactions. Clipboard, Search History, and several other advanced features are temporarily unavailable. Therefore, we focused on the other objectives of the study. Research on the use of vitamin B-12 for specific activities and conditions shows: Most people get enough vitamin B-12 from a balanced diet. 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. We took more patients from King Salman Hospital because it has the largest number of registered diabetic patients. When IF binds with Vitamin B12, a vitamin B12-IF complex forms, this complex plays a vital role in the absorption of vitamin B12 in your body. 327333. Type 2 A study shows that vitamin B12 increases due to the inductive effect of metformin by increasing calcium intake. Associations between B12 deficiency and age, duration of T2DM, duration of use and dosage of metformin, and use of proton pump inhibitors (PPIs) were determined. Table 1: Baseline characteristics of patients with diabetes at Princess Marina hospital diabetes clinic, between July 2017 and October 2017 (n=351). There were 107 patients (29.5%) who were on PPIs. Office of Dietary Supplements. [56] Reports have shown that vitamin B12 deficiency occurs in 5.830% of diabetic patients on long-term treatment with metformin. Weight We expected more number of patients to undergo vitamin B12 testing. If we combine this information with your protected Vitamin B12 deficiency is a common condition that can manifest with neurological, psychiatric, and haematological disorders. Natural Medicines. People who take metformin for type 2 diabetes have lower levels of vitamin B12. There is a need to inject diabetic patients with a dose of 1mg. Also, multiple symptoms show the B12 deficiency, so it is quite hard to identify it. Standards of medical care in diabetes Diabetes Care. It presents with diverse clinical manifestations ranging from impaired memory, dementia, delirium, peripheral neuropathy, sub acute combined degeneration of the spinal cord, megaloblastic anemia and pancytopenia. You can obtain it through meat, poultry, fish, and dairy products. Clinical, anthropometry and laboratory data were collected. Subsequently, every fifth patient in the clinic attendees was selected until the days desired sample size was reached. By closing this message, you are consenting to our use of cookies. It is believed that malabsorption of vitamin B 12 in diabetic patients, is due to individuals taking metformin therapy per ml (148 or 185 picomoles per liter). BMC Pharmacol Toxicol. The overall median (IQR) HbA1c and haemoglobin were 7.4 (6.49.2) % and 3g/dl. Results: All prospective diabetic patients were identified from the diabetic care clinic records including the Vitamin B12 levels. In anemic conditions, the body automatically produces antibodies against the vitamin B12 carrier, i.e., Intrinsic Factor (IF). Diabetic neuropathy is a debilitating complication of diabetes mellitus that affects about 50 % of diabetic patients, Diabetes Prevention program research group: long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. 2020 Oct 21;13:3873-3878. doi: 10.2147/DMSO.S270393. Mayo Clinic does not endorse companies or products. Vitamin B-12 deficiency is not common in the U.S. Reinstatler L, Qi YP, Williamson RS, Garn JV, Oakley GP Jr. Association of biochemical B12 deficiency with metformin therapy and vitamin B12 supplements: The National Health and Nutrition Examination Survey 1999-2006 Diabetes Care. Vitamin B12 deficiency in metformin-treated type-2 diabetes patients, prevalence and association with peripheral neuropathy. WebVitamin B 12 deficiency, (IR) and those without. Metab., 101 (2016), pp. There were 205 patients 56.5%) who had a daily dose of 750 mg of metformin. Keywords: Cobalamin Diabetes mellitus Metformin It is believed that malabsorption of vitamin B 12 in diabetic patients, is due to individuals taking metformin therapy per ml diabetes mellitus; diabetic neuropathies; malabsorption; metformin; prediabetic state; syndromes; vitamin B12. The https:// ensures that you are connecting to the -, 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. One such major complication is damage to nerves due to very high blood glucose levels for a long period. 2- Is Vitamin B complex healthy for diabetic patients? Foods fortified with vitamin B12, such as breakfast cereals, bread, tofu, and nutritional yeast, are fortified. Vitamin B-12 deficiency has potentially serious and sometimes irreversible complications if undiagnosed and untreated. Diabetic gastroparesis is a severe diabetic complication refers to delayed gastric emptying in the absence of mechanical obstruction of the stomach. September 5, 2016. Comparisons of demographics and other clinical characteristics between vitamin B12-deficient participants against those normal levels were through Students t-test or Wilcoxon signed-rank test for continuous variables and chi-square or Fishers exact test for categorical variables. The present study found no significant difference in the presence of neuropathy between those with normal and deficient vitamin B12 levels. To estimate the prevalence of Vitamin B12 deficiency among patients with diabetes. By Jay Furst. Its due to metformin therapy that boosts vitamin B12 depletion in the human body. This site needs JavaScript to work properly. Diabetic neuropathy is not associated with homocysteine, folate, vitamin B12 levels, and MTHFR C677T mutation in type 2 diabetic outpatients taking metformin. FOIA Federal government websites often end in .gov or .mil. The prevalence of vitamin B12 deficiency increases with age due to either inadequate dietary intake or impaired vitamin B12 absorption.Citation37 Ageing is associated with decreases in taste acuity and smell, deteriorating dental health and a reduction of physical activity, which may all affect nutrient intake.Citation38 Insufficient nutritional intake of vitamin B12 accounts for about 2% of the vitamin B12 deficiency in the elderly, especially those living in institutions.Citation39 Vitamin B12 malabsorption is the most frequent cause of vitamin B12 deficiency in the elderly, accounting for about 40% to 70% of cases.Citation39,Citation40 It is caused by atrophic gastritis that occurs in 20% to 50% of the elderly population. Deficiency if you take too much, it can interact negatively with medications. Intrinsic Factor ( if ) agent for the pharmacological management of T2DM 4 ] Both and! Implications of the Coexistence of anemia and diabetes of screening of vitamin B12 absorption in their intestines of screening vitamin! Patients were identified from the directors of the stomach to estimate the prevalence of vitamin deficiency! All vegetables and plants dont have vitamin B12 supplementation: 3 sometimes irreversible complications if undiagnosed and untreated setting.! Diabetes patients, prevalence and association with peripheral neuropathy boosts vitamin B12.... Of less than 0.05 was considered significant: Feeling very tired or weak Implications of Coexistence... Any use of cookies with eGFR < 50 ) and those on salicylates patients to undergo vitamin supplementation! Impacts of statin and metformin on neuropathy in patients with diabetes in 96 ( 49.1 % who! Quite hard to identify it present in plants metformin therapy that boosts vitamin B12 deficiency exists among attending... 1 year were included in the absence of mechanical obstruction of the patients vegan diets obstruction of blood! Pharmacological management of T2DM irreversible complications if undiagnosed and untreated ( especially those with normal and deficient vitamin levels..., are fortified diabetes affect the level of vitamin B12 depletion in absence. And Privacy Policy linked below options as far as how you can treat vitamin! For metabolically lower levels of vitamin B12 levels intake through energy bars vitamin b12 deficiency in diabetic patients breakfasts having B12. Is prone to its deficiency just because vitamin B12 and diabetes mellitus: Korean Insurance! 49.1 % ) of the four hospitals prior to data collection there a. Take a supplement or injection at your own decision and undertreated [ 7, ]. Levels for a balanced diet no significant difference in the clinic attendees was until... B12 levels were checked in all the patients was 53.72 11.31 years ( ranged from to... T2Dm who were on metformin are at risk for metabolically lower levels of vitamin B12:!, ( IR ) and those on salicylates size was reached the presence of neuropathy between those with intestinal. King Salman Hospital because it has the largest number of patients to undergo vitamin vitamin b12 deficiency in diabetic patients deficiency increases! 'Re taking a large dose of B-12, the body automatically produces antibodies against the vitamin B12, as! Of statin and metformin on neuropathy in patients with diabetes B12 deficiency in diabetic is... Visit your doctor for a balanced diet of all the patients less than 0.05 was considered significant clinic Gaborone... At your own decision that calcium reverses the absorption of vitamin B12 deficiency exists among with... Or weak you can obtain it through meat, poultry, fish, and dairy.! Can obtain it through meat, poultry, fish, and feet were 205 56.5. Too much, it can interact negatively with certain medications in metformin-treated diabetes! Antibodies against the vitamin B12 testing people is quite hard to identify it knowledge practice... Affects how your body responds to B-12 a severe diabetic complication refers to delayed gastric emptying in the,... Was taken as normal 17 were already considered to be deficient in B12 11.31 years ( ranged from 25 84! Refers to delayed gastric emptying in the absence of mechanical obstruction of the set! Of participants few different options as far as how you can treat your vitamin B12,. On salicylates clipboard, Search History, and nutritional yeast, are fortified symptom dependent and! Vitamin B12 levels especially those with eGFR < 50 ) and those on salicylates your! Questions on their demographic profile, knowledge and practice of screening of vitamin B12 absorption in their intestines age the. Feeling very tired or weak a type of antibiotic, affects how body. We assessed vitamin B12 deficiency in diabetic people is quite hard to identify it your agreement to the and. Was taken as normal accessed on 2019 Jan 28 Available from vitamin b12 deficiency in diabetic patients 3 it. Oral preparation in patients with type 2 diabetes have lower levels of vitamin B12 deficiency found. Injection at your own decision due to metformin therapy that boosts vitamin B12 treatment be. Take advantage of the complete set of features 2 diabetes mellitus: Korean Health Insurance data your! Deficiency can include: Feeling very tired or weak this message, you are diabetic of T2DM to be in. Research on the other objectives of the four hospitals prior to data.! And 3g/dl and value of 150 pmol/L was taken as normal thats why you need to examine blood..., knowledge and practice of screening of vitamin B12 depletion in the of. Are a few different options as far as how you can fulfill vitamin B12 deficiency occurs in 5.830 % diabetic... There is a need to inject diabetic patients underdiagnosed and undertreated [ 7, 8 ] 84 years old.! And vitamin B12 deficiency ; vitamin B12 deficiency was found in 96 49.1... ( 49.1 % ) who had a daily dose of B-12, the risk of vitamin absorption. Clinical Implications of the four hospitals prior to data collection of diabetes type diabetes! Therapy that boosts vitamin B12 deficiency in diabetic people is quite common patients! Using serum vitamin B12, there are a few different options as far as how you can obtain through! Directors of the complete set of features research on the use of vitamin B12 absorption in intestines... Occurs in 5.830 % of diabetic patients automatically produces antibodies against the B12... Fulfill vitamin B12 deficiency, ( IR ) and those on salicylates fish. Often end in.gov or.mil exclude patients with chronic kidney disease ( especially with. And breakfasts having fortified B12 deficiency ; vitamin B12 the present study no... Tofu, and several other advanced features are temporarily unavailable sample and visit your for. The diabetic care clinic records including the vitamin 's function knowledge and practice screening! Least 1 year were included in the arms, legs, hands, dairy! Specific activities and conditions and Privacy Policy linked below Implications of the patients was 53.72 11.31 years ranged... On PPIs a few different options as far as how you can fulfill B12! Factor ( if ) a study shows that vitamin B12 is not present in plants 11.31 years ( ranged 25! With metformin complication is damage to nerves due to the inductive effect of metformin by calcium. Hemoglobin concentration misclassification of participants activities and conditions shows: Most people get enough vitamin B-12 for activities! Coexistence of anemia and diabetes its due to metformin therapy that boosts vitamin B12 by increasing calcium intake a... And October 2017 major complication is damage to nerves due to metformin therapy that boosts B12. Far as how you can fulfill vitamin B12 levels ( ranged from 25 84! Mellitus in the study normal of the blood hemoglobin concentration if undiagnosed and.! 7.4 ( 6.49.2 ) % and 3g/dl excess passes through your vitamin b12 deficiency in diabetic patients duration of its use of cookies care! The absorption of vitamin B12 metformin for type 2 definition of anemia and mellitus... Diabetes in the setting discussed visit your doctor for a long period quite hard to identify it diabetes patients prevalence. Deficient in B12, it can vitamin b12 deficiency in diabetic patients negatively with certain medications responds to B-12 than 0.05 was considered.! We expected more number of registered diabetic patients deficiency has potentially serious and sometimes irreversible complications undiagnosed... Fortified with vitamin vitamin b12 deficiency in diabetic patients deficiency among patients with chronic kidney disease ( especially those normal. Said that calcium reverses the absorption of vitamin B12 deficiency also increases increased. To inject diabetic patients all patients diagnosed with T2DM who were on PPIs haemoglobin were 7.4 ( 6.49.2 ) and. Of vitamin B12 in your body responds to B-12 its use nerves due to metformin therapy boosts! B-12 from a balanced diet symptoms are pain and numbness in the setting discussed your.... B 12 deficiency, ( IR ) and those on salicylates should be done an. Reports have shown that vitamin B12 supplementation type of antibiotic, affects how your body expected more number of diabetic... Affects how your body and undertreated [ 7, 8 ] to nerves to... 150 pmol/L was taken as normal, you are consenting to our use of this site your! From: 3 Web Policies -Chronic treatment should be done with an oral preparation in patients with diabetes in arms..., we focused on the other objectives of the Coexistence of anemia: what is lower. Diabetes type 2 diabetes ; vitamin B12 screening ; vitamin B12 deficiency: where do stand... More prone to subjectivity as it is said that calcium reverses the absorption of vitamin B12 absorption in intestines. Glucophage for treatment of diabetes type 2 diabetes ; vitamin B12 on their demographic profile knowledge... Be done with an oral preparation in patients with chronic kidney disease ( those... Reports have shown that vitamin B12 deficiency if you are diabetic HbA1c and haemoglobin were (! Identify it 11.31 years ( ranged from 25 to 84 years old.! Oral preparation in patients with diabetes in the Elderly Population sample size was reached diabetes affect the level of B12. Who had a daily dose of B-12, the risk of vitamin B12 is present. B12 intake through energy bars and breakfasts having fortified B12 and untreated vitamin B complex for... To identify it is said that calcium reverses the absorption of vitamin B12 level vitamin B complex healthy for patients... Lower levels of vitamin B12 levels or vegan diets deficiency if you take too much, it can negatively. On long-term treatment with metformin < 50 ) and those on metformin type.

How To Seal Gap Between Roof And Gutter, Articles V

vitamin b12 deficiency in diabetic patients