Abstract
Type 2 Diabetes mellitus is a chronic metabolic disorder with complications of microangiopathies, macroangiopathies, neuropathy and nephropathy. Metformin is often the first line treatment in type 2 diabetes. There is evidence of a higher prevalence of vitamin B12 deficiency observed among patients on metformin. It is believed that Metformin may cause vitamin B12 malabsorption which aggravates neuropathy and anaemia.
Methods
A cross-sectional study was designed with randomly selected type 2 diabetes patients attending a tertiary diabetes clinic in Southern India, recruited over a period of 3 months, divided in 2 groups (control and study groups) based on their use of metformin. They were assessed for serum B12, Folic acid levels and mean corpuscular volume. Clinical manifestations of neuropathy, anaemia and vitamin B12 deficiency were documented on clinical examination.
Results
There were 100 patients recruited, showing those on metformin had a higher prevalence of vitamin B12 deficiency (58.3% vs 33.3%, p<0.05), however, folic acid deficiency was lower (16.7% vs 37.5%, p<0.05).
Conclusion
Patients with type 2 diabetes on metformin required protocols for monitoring and replacement of vitamin B12 as necessary, to prevent onset of neuropathy.
References
Anil Kumar R, Surekha B. Shetty, Lalitha R. Prevalence of vitamin B12 deficiency in Indian type 2 diabetes subjects on metformin therapy. Int J Med Res Rev 2017;5(09): 845-850.doi:10.17511/ijmrr. 2017.i09.03.
Agarwal P, Mital P, et al. A comparative study of levels of vitamin B12 in patients of type 2 diabetes mellitus on metformin and not on metformin at tertiary care center. Int J Adv. Med 2016;3:759-63.
Nareddy VA, Boddikuri IP, Ubedullah SK, Papareddy A, Miriyam MK. Correlation of Vit B12 levels with metformin usage among type 2 diabetic patients in a tertiary care hospital. Int J Adv Med 2018;5:1128.
Carmel R, Rosenberg AH, Lau KS, Streiff RR, Herbert V. Vitamin B12 uptake by human small bowel homogenate and its enhancement by intrinsic factor. Gastroenterology 1969 Mar;56(3):548-555.
Marwan Awad Ahmed. Metformin and Vit B12 Deficiency/ Where do we stand. J Pharm Sci (www.cspsCanada.org) 19(3) 382 - 398, 2016
Mohammed El-Sherif, Manal Hashem et al, Is there a relationship between exacerbated Diabetic Peripheral Neuropathy and Metformin? Neurology Apr 2018, 90 (15 Supplementation) P2.430.
Turki J. Alhari, Ayla M. Tourkmani, Osama Adelhav et al. The association of metformin use with vitamin B12 deficiency and peripheral neuropathy in Saudi Individuals with type 2 diabetes mellitus. PLoSOne. 2018;13(10):e0204420
Penninx BW, Guralnik JM, Ferrucci L, et al. Vitamin B (12) deficiency and depression in physically disabled older women: epidemiologic evidence from the Women's Health and Aging Study. Am J Psychiatry 2000 May; 157(5): 715-721.
Moore EM, Mander AG, et al. Increased risk of cognitive impairment in patients with diabetes is associated with metformin. Diabetes Care 2013 Oct;36(10):2981- 2987.
Gale EA, Gillespie KM. Diabetes and gender. Diabetologia. 2001;44(1):3-15
Hoogeveen EK, Kostense PJ, Bouter LM, Heine RJ, Stehouwer CD. Does metformin increase the serum total homocysteine level in non-insulin-dependent diabetes mellitus? J Intern Med 1997 Nov; 242 (5): 389-394.
Yajnik CS, Deshpande SS, Lubree HG, Naik SS, Bhat DS, Uradey BS, Deshpande JA, Rege SS, Refsum H, Yudkin JS. Vitamin B12 deficiency and hyperhomocysteinemia in rural and urban Indians. J Assoc Physicians India. 2006 oct; 54:775-82. PMID:17214273.
Kumawat BL, Sharma cm, Shah mj, Panchal MA. Hyperhomocysteinuria and Vitamin B12 deficiency as a risk factor for ischemic stroke: A case-control study from Northwestern India. Indian J Health Sci Biomed Res 2018;11:228-33
Pongchaidecha M, Srikusalanukul V, Chattananon A, Tanjariyaporn S. Effect of metformin on plasma homocysteine, vitamin B12 and folic acid: cross sectional study in patients with type 2 diabetes mellitus. J Med Assoc Thai 2004 Jul;87(7):780-787.
Wile DJ, Toth C. Association of metformin, elevated homocysteine and methyl malonic acid levels and clinically worsened diabetic peripheral neuropathy. Diabetes Care 2010 Jan;33(1):156-161.
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