vitamin b12 deficiency in diabetic patients

Left untreated, a vitamin B-12 deficiency can lead to anemia, fatigue, muscle weakness, intestinal problems, nerve damage and mood disturbances. You can control blood glucose level in your body by increasing intake of vitamin B12. We expected more number of patients to undergo vitamin B12 testing. In the human body, the small intestine is the part where absorption of Vitamin B12 takes place. You may be trying to access this site from a secured browser on the server. Diabetes Metab. By using metformin for a long period, the absorption of vitamin B12 will be reduced in your body. PMC Careers. Symptoms of potential nervous system problems include: Confusion. Independent t-test was performed to determine the significant difference between continuous variables. Generally, vitamin B12 supplements start showing their effect after 48 to 72 hours of the initial dose. Most (89.5%) participants were on metformin. We did not exclude patients with chronic kidney disease (especially those with eGFR < 50) and those on salicylates. You can obtain it through meat, poultry, fish, and dairy products. Metformin; type 2 diabetes; Vitamin B12 deficiency; Vitamin B12 screening; Vitamin B12 supplementation. Vitamin B12 deficiency in diabetic people is quite common. The majority were females (67.2%) and those with type 2 diabetes (92.9%). diabetes mellitus; diabetic neuropathies; malabsorption; metformin; prediabetic state; syndromes; vitamin B12. https://naturalmedicines.therapeuticresearch.com. To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. To activate receptors of your small intestine, you also have to take calcium regularly for complete absorption of vitamin B12. An estimated sample size of 354 patients was calculated. WebNo correlation was found between vitamin B 12 plasma levels and metformin treatment time or dosage. J. Clin. 2016;134:4739, 22. This vitamin is needed to make red blood cells, which carry oxygen to all parts of your body. Ko SH, Ahn YB, Song KH, Han KD, Park YM, Kim HS. There were only 16 patients (4.4%) who had available serum vitamin B12 levels. Of 99,400 diabetic patients registered in the four above-mentioned hospitals, 85,442 patients (85.95%) were from King Salman Hospital, 8,624 (8.67%) were from King Saud Medical City, 3,780 (3.80%) were from Imam Abdulrahman Alfaisal Hospital and 1,554 (1.56%) were from Prince Mohammad bin Abdulaziz Hospital. Conclusions: In diabetes, blood glucose level goes low 2006;35:2001, 6. He is also a recipient of several awards and honors. CAN occurs when nerve damage affects the heart, which can be caused by prolonged hyperglycemia over several years in people with diabetes. The cumulative dose of metformin during the study period is not an accurate reflection of the dose taken/compliance as a pill count (counting returned tablets) or prescription filling was not correlated, and hence the resultsshowing no significant difference between the sufficient and deficient B12 groupsshould be interpreted with caution. The mean daily dose of metformin was 984.85 320.96 mg (range: 5002000 mg). Min HK, Kim SH, Choi JH, Choi K, Kim HR, Lee SH. suggested that the mechanism for this vitamin B12 deficiency is caused by the slowed intestinal transit time among diabetics causing bacterial overgrowth and eventually B12 malabsorption. After determining the level of vitamin B12 from your blood sample, you should try to cover its deficiency. Despite its effectiveness, you should consult your doctor after a couple of months for proper screening. Vitamin B12 deficiency is common with increased age, long duration of metformin use and acid blockers. Another serious thing that may happen to vitamin B12 deficient people is loss of smell and taste sensations. We used a researcher-administered questionnaire to obtain information on patients age, sex, HIV status, diabetes type and diabetes duration. Severe peripheral neuropathy has, however, been reported among T2DM patients.Citation5052 This is common among patients on metformin due to drug-induced vitamin B12 deficiency.Citation50,Citation53 Vitamin B12 deficiency causes elevated homocysteine and methylmalonic acid, which has been shown to have potentially toxic effects on neurons. Gastritis is due to either Helicobacter pylori (H. pylori) infection or autoimmune mechanisms.Citation41,Citation42 H. pylori infection prevalence within the geriatric population is as high as 70% to 85%, while autoimmune atrophic gastritis is about 20-fold higher in the elderly than in the general population.Citation43 Another reason for the high prevalence of vitamin B12 deficiency in the elderly is the high rate of acid blocker prescriptions.Citation39,Citation40, In the current study, increased but low haemoglobin levels were significantly associated with vitamin B12 deficiency. In those with diabetic neuropathy, altered (low and borderline) vitamin B12 level was 64% (95% CI: 47-78%) compared to 17% (95% CI: 10-26%) in patients without diabetic neuropathy (coefficient: -110.8; CI 95%: -165.8, -59.7). Natural Medicines. Clipboard, Search History, and several other advanced features are temporarily unavailable. MeSH Vegans and vegetarians are more prone to its deficiency just because vitamin B12 is not present in plants. Top Warning Signs of B12 DeficiencyTiredness. If you often feel exhausted, regardless of how much sleep youve gotten or how much energy youve exerted, it could be a sign that your body is lacking Mood swings. Do you find yourself experiencing a variety of emotions throughout any given day? It may result in depression. Digestive issues. Inflammation of the mouth and tongue. Insomnia. More items Taking omeprazole (Prilosec), lansoprazole (Prevacid) or Forty-four (44.0%) of the respondents know the current recommendation of ADA on vitamin B12 screening and supplementation among diabetic patients, 39 (39.0%) do not know about the current recommendation, whereas 17 (17.0%) have no idea about the recommendation. Zhang YH, Guo W, Zeng T, Zhang S, Chen L, Gamarra M, Mansour RF, Escorcia-Gutierrez J, Huang T, Cai YD. Objective: A linear regression model was used to evaluate variables that correlated with vitamin B12 levels and diabetic neuropathy. The 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. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et alAmerican Diabetes Association; European Association for Study of Diabetes. The most notable risk factor associated with vitamin B12 deficiency in adult individuals with diabetes in clinical practice is long term and high dose metformin therapy [46]. The site is secure. 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. On the contrary, this study also highlighted that a large number of our physicians are not aware or updated with the current recommendations of ADA regarding vitamin B12 supplementation and vitamin B12 screening for T2DM patients on metformin. Some people suffer from serious symptoms such as shortness of breath, dizziness, fatigue, and a fast heartbeat. In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. information is beneficial, we may combine your email and website usage information with The mean (SD) age of the participants was 57 (15) years, two-thirds (67.2%) were females, and the majority (92.9%) had Type 2 diabetes. Epub 2015 Mar 9. 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 Accessed Jan. 9, 2021. The https:// ensures that you are connecting to the 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]). Endocrinol. Causes and pathophysiology of vitamin B12 and folate deficiencies. Accessed Jan. 9, 2021. The use of vitamin B12 supplement was significant among patients 46 years old and above [Table 4]. Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. Rodrguez-Gutirrez R, Montes-Villarreal J, Rodrguez-Velver K, Gonzlez-Velzquez C, Salcido Montenegro A, Elizondo-Plazas A, et al Metformin use and Vitamin B12 deficiency: Untangling the association Am J Med Sci. 2017;9:725, 24. 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. Its not only the vitamin B12 that we intake orally. On average, diabetic patients should take 300 mcg of biotin, 150 mcg of B12, 1.5 mg of B1, 75 mg of B6, 25 mg of B2, and 2.5 mg of folic acid. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Vieira IH, Barros LM, Baptista CF, Rodrigues DM, Paiva IM. There is a problem with Due to deficiency of B12 vitamin, the level of blood glucose decreases. People who don't get enough vitamin B-12 may have a higher risk of neuropathy and other nervous system (neurological) problems. This cross-sectional study was conducted at the diabetic clinics at four selected MoH hospitals in Riyadh, Saudi Arabia (King Salman Hospital, King Saud Medical City, Imam Abdulrahman Alfaisal Hospital and Prince Mohammad bin Abdulaziz Hospital) between August and November 2018. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. PMC 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. 1- Does vitamin B12 is crucial for lowering blood sugar? Also, a single-centre nature of the study limits the generalisation of the study findings. World J Diabetes. health information, we will treat all of that information as protected health The duration of metformin use is dependent on the patients history and thus subject to recall bias. doi: 10.1002/14651858.CD004514. The use of vitamin B12 supplement was significantly higher among females (p < 0.001). There were 107 patients (29.5%) who were on PPIs. 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. Of 363 T2DM patients, 206 (56.7%) were males and 157 (43.3%) were females, mean age was 53.72 11.31 years, the mean duration of T2DM was 9.89 7.32 years, and the mean duration of metformin use was 9.84 7.29 years. Clinical Implications of the Coexistence of Anemia and Diabetes Mellitus in the Elderly Population. Diabetic patients should choose a diet that contains B12, else they will face a severe deficiency of this vitamin. 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. There was no difference in the prevalence of peripheral neuropathy in those with normal vitamin B12 levels and those with vitamin B12 deficiency. If we combine this information with your protected https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional. You may opt-out of email communications at any time by clicking on 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. 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). Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. J. Clin. Vitamin B12 deficiency resulting from metformin use has been demonstrated in multiple studies. FOIA Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. Articles in Google Scholar by Amal N. Alshammari, Other articles in this journal by Amal N. Alshammari, Privacy Policy (Updated December 15, 2022). The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Because there is a possibility that taking vitamin B12 pills will not be the right choice for you. 2021 Nov 26;9(33):10198-10207. doi: 10.12998/wjcc.v9.i33.10198. There is a need to inject diabetic patients with a dose of 1mg. 2022 Aug 20;14(8):e28194. In this study an inverse correlation was found between diabetic neuropathy Conclusions In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B 12 plasma levels. Metformin is the base of medicine in the treatment of type 2 diabetes mellitus (T2DM) with estimates that it is frequently approved and recommended to 120 million patients with diabetes globally. 2015 Dec;41(6):550-5. doi: 10.1016/j.encep.2015.07.004. Authors: News Author: Laurie Barclay, MD CME Author: Hien T. Nghiem, MD Log In to Start To assess the knowledge and practice of physicians about screening for vitamin B12 deficiency in metformin-treated diabetic patients, a self-administered questionnaire was distributed to all physicians conducting diabetic clinics in above-mentioned hospitals. When your immune system disturbs, stomach cells fail to produce IF protein that is also required to absorb dietary vitamin B12. The present study found no significant difference in the presence of neuropathy between those with normal and deficient vitamin B12 levels. For more information, please refer to our Privacy Policy. Owhin SO, Adaja TM, Fasipe OJ, Akhideno PE, Kalejaiye OO, Kehinde MO. Food sources of vitamin B-12 include poultry, meat, fish and dairy products. 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. Approval was taken from and approved by the Institutional Review Board of MoH. Register to receive personalised research and resources by email. Long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. Proton pump inhibitors. Type 2 J Pak Med Assoc. Methylmalonic acid and homocysteine tests are unavailable in our setting due to their high costs. 965972. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). There was no difference in the prevalence of peripheral neuropathy between those with normal and deficient vitamin B12 levels. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. Irritability. Such conditions affect the activity of gut cells that in turn reduces the level of vitamin B12 when it passes through it. Fairfield KM. Means RT Jr, et al. Vitamin B 12 deficiency associated with metformin is relatively common in our area. Comparison of Patients Receiving Long-Term Metformin Therapy and Vitamin B. Lets discuss vitamin B12 deficiency, its reasons, and why its deficiency is serious for diabetes patients. Vitamin B12 deficiency due to metformin occurs because it interferes with the complex of B12-IF. Did you know that with a free Taylor & Francis Online account you can gain access to the following benefits? There are some limitations of this current study. An official website of the United States government. Front Microbiol. Metab., 101 (2016), pp. Using metformin therapy for a long time is a cost-effective and practical treatment of blood glucose level maintenance. The best way to treat low-level of vitamin B12 is by excessive intake of fortified bread, cereals, eggs, and milk. and transmitted securely. WebFrequent doses of metformin can result in vitamin b12 deficiency. Folic acid with or without vitamin B12 for cognition and dementia. 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 If a patients mood is low at the same time, this can easily be interpreted as depression. WebMetformin and Vitamin B12 Deficiency Diabetes Discoveries & Practice Blog Metformin and Vitamin B12 Deficiency April 25, 2018 0 Comments Research Advancements Medication (10.1210/jc.2015-3754) BMJ 2010. c2181. Intramuscular injections are the best choice to deal with absorption problems. Accessibility Cyanocobalamin. Patients were given a single tablet of B vitamins containing 2.5 milligrams of folic acid, The average B12 level in the blood was 223pg/ml. Not only are consuming vitamins and minerals healthy, but your body should also absorb them efficiently. [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. 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. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. This outpatient cross-sectional study found 6.6% of patients with diabetes at Princess Marina Hospital diabetes clinic to be vitamin B12 deficient. Of the 16 patients who had vitamin B12 levels, two (12.5%) had vitamin B12 level below 200 pg/mL. In short, the long-term deficiency of vitamin B12 causes serious symptoms like depression, delusion, difficulty in walking, loss of mobility, seizures, and dementia. Federal government websites often end in .gov or .mil. Highlight selected keywords in the article text. Routine testing for serum vitamin B12 level is not practiced in our institution. The mean duration of T2DM was 10.27 7.99 years (range of 2.026.0 years) and the mean duration of metformin use was 10.27 7.99 years (range of 2.026.0 years). A P value of < 0.05 was considered statistically significant. Alshammari, Amal N.1,; Iqbal, Rafay1; Baksh, Iqra Peer2, 1Department of Family and Community Medicine, Joint Program, Riyadh, Saudi Arabia, 2Department of Dermatology, General Practitioner, Riyadh, Saudi Arabia, Address for correspondence: Dr. Amal N. Alshammari, Department of Family and Community Medicine, Joint Program, Resident R 3, Riyadh, Saudi Arabia. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. Proactively addressing the risk of developing low vitamin B 12 levels in this patient population not only reduces potential physical and mental sequelae but also lessens the financial burden of disease, appointments, testing, loss of Bookshelf The deficiency was significantly common with increased age, long duration of metformin use, and acid blockers. Table 2: Factors associated with Vitamin B12 deficiency among patients with diabetes at Princess Marina Hospital diabetes clinic, between July 2017 and October 2017. In anemic conditions, the body automatically produces antibodies against the vitamin B12 carrier, i.e., Intrinsic Factor (IF). The overall median (IQR) HbA1c and haemoglobin were 7.4 (6.49.2) % and 3g/dl. 34 The prevalence of anemia and mean corpuscular volume did not differ between T2DM-met patients with and without B12 deficiency (23.1% versus 31.3% and 89.4 fl versus 89.0 fl, respectively). Advertising revenue supports our not-for-profit mission. In a case-control study among Medicaid patients in the USA, vitamin B12 deficiency was found in 18% of patients using acid blockers compared with 11% in the control group.Citation32 Other previous studies have, however, found no significant association between long-term proton pump inhibitor use and vitamin B12 status.Citation8,Citation33 The connection between vitamin B12 deficiency and proton pump inhibitors or H2 blockers (acid blockers) is primarily due to decreased gastric acidity, contributing to vitamin B12 malabsorption.Citation34 Both the acid blockers and proton pump inhibitors cause a reduction in secretion and discharge of acid discharges by the parietal cells, which are essential for the breakdown of vitamin B12 from nutritional sources.Citation10,Citation34,Citation35 In the absence of gastric acid, vitamin B12 would not be cleaved from dietary protein and would not bind to R-proteins. eCollection 2020. Vitamin B12 is a water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function.Citation1 The prevalence of vitamin B12 deficiency in diabetes mellitus (DM) ranges between 5.8% and 52%.Citation28 The association of vitamin B12 deficiency and Type 2 diabetes (T2DM) is mainly due to metformins long-term use, as demonstrated by evidence from both observational and interventional studies.Citation1,Citation8 This associations exact mechanism is unknown but has been ascribed to intestinal malabsorption of vitamin B12 due to metformin.Citation9,Citation10 Pernicious anaemia, which is characterised by an autoimmune-mediated chronic atrophic gastritis, is a classically described cause of vitamin B12 deficiency among type 1 diabetes patients.Citation11 As vitamin B12-related hematologic and neuropsychiatric disorders are reversible by early diagnosis, regular assessment of vitamin B12 levels is essential.Citation2 Prompt treatment may be important in patients with diabetes.Citation12 As the prevalence of vitamin B12 deficiency in patients with diabetes in Botswana is unknown, this study was undertaken to estimate the prevalence of Vitamin B12 deficiency among patients with diabetes. 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. World J Clin Cases. Keywords: Cobalamin Diabetes mellitus Metformin Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. Russo GT, Giandalia A, Romeo EL, Scarcella C, Gambadoro N, Zingale R, Forte F, Perdichizzi G, Alibrandi A, Cucinotta D. J Endocrinol Invest. Subsequently, every fifth patient in the clinic attendees was selected until the days desired sample size was reached. You might be thinking about how you can take vitamin B12 naturally when you are a vegetarian. 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. Treatment Of B12 Deficiency In Diabetes Patients. Treatment Of B12 Deficiency In Diabetes Patients. Of all the patients 17 were already considered to be deficient in B12. Using an assumed proportion of 9.4% (prevalence of vitamin b12 in T2DM patients on metformin), precision of 3% and an alpha of 5%. Liu et al. Michalak SS, Wolny-Rokicka E, Nowakowska E, Michalak M, Gil L. J Diabetes Res. Pflipsen M, Oh R, Saguil A, Seehusen D, Seaquist D, Topolski R. The prevalence of vitamin B12 deficiency in patients with type 2 diabetes: A cross-sectional study J Am Board Fam Med. Many such vitamin B12 rich foods can be obtained from animal and non-animal sources. WHO Media Centre. Vitamin B-12 is an essential vitamin for diabetes patients as it promotes healthy blood cells and nervous system. Vitamin B-12 supplements also are recommended for women who are pregnant or breastfeeding exclusively and follow vegetarian or vegan diets. 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. 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. Routine testing for serum vitamin B12 level is not practiced in our institution.
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