and transmitted securely. Lam DW, LeRoith D. The worldwide diabetes epidemic Curr Opin Endocrinol Diabetes Obes. Metab., 101 (2016), pp. Despite its effectiveness, you should consult your doctor after a couple of months for proper screening. September 5, 2016. WebNo correlation was found between vitamin B 12 plasma levels and metformin treatment time or dosage. 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 Your body absorbs only as much as it needs, and any excess passes through your urine. eCollection 2022 Aug. Farland MZ, McPheeters CM, Renwick RC, Barlow PB, Williams JD, Keeble DS, Franks AS. Conclusions: [1], The number of persons with diabetes has risen from 108 million in 1980 to 422 million in 2014. [28] Type 2 diabetics particularly those on metformin are at risk for metabolically lower levels of vitamin B12. Vitamin B12 affects the dynamics of autonomic nervous system and its deficits has been linked to cardiovascular autonomic neuropathy therefore, vitamin B12 deficiency was (10.1136/bmj.c2181) If youre The deficiency was significantly common with increased age, long duration of metformin use, and acid blockers. WebVitamin B 12 deficiency, (IR) and those without. 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. Please enable it to take advantage of the complete set of features! The data collection was done in the clinic using a data extraction form. 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. Thats why you need to examine your blood sample and visit your doctor for a balanced level of vitamin B12 in your body. A total of 100 physicians responded and consented to participate in the study. 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. 2013;71:38690, 12. 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. Such patients are also more vulnerable to pernicious Armenia. Unauthorized use of these marks is strictly prohibited. Vitamin B12 status and peripheral neuropathy in patients with type 2 diabetes mellitus. Another serious thing that may happen to vitamin B12 deficient people is loss of smell and taste sensations. Bookshelf One such major complication is damage to nerves due to very high blood glucose levels for a long period. Albai O, Timar B, Paun DL, Sima A, Roman D, Timar R. Diabetes Metab Syndr Obes. Disclaimer. Natural Medicines. Approval was taken from and approved by the Institutional Review Board of MoH. IBM Micromedex. Due to deficiency of B12 vitamin, the level of blood glucose decreases. 2009;32:193203, 28. 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. Cochrane Database Syst Rev. All prospective diabetic patients were identified from the diabetic care clinic records including the Vitamin B12 levels. Vitamin B12 is an essential micronutrient required for optimal hemopoetic, neuro-cognitive and cardiovascular function. J Pak Med Assoc. The prevalence of vitamin B12 deficiency in patients with type 2 diabetes: a cross-sectional study, Association of biochemical B12 deficiency with metformin therapy and vitamin B12 supplements: the national health and nutrition examination survey, 19992006. The worldwide prevalence of diabetes is high including Saudi Arabia. You can obtain it through meat, poultry, fish, and dairy products. Highlight selected keywords in the article text. 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. Berchtold P, Bolli P, Arbenz U, Keiser G. Disturbance of intestinal absorption following metformin therapy (observations on the mode of action of biguanides) [in German]. 4 How long do vitamin B12 supplements take to work for diabetes treatment? 2012;122:25370, 5. 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. There were 206 (56.7%) males and 157 (43.3%) females, and 337 (92.8%) were Saudis. Antiparietal cell antibodies occur in 90% of patients with pernicious anemia but in only 5% of healthy adults. We chose the four hospitals according to availability of Vitamin B12 test. E-mail: [emailprotected]. The .gov means its official. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. [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. Vegans and vegetarians are more prone to its deficiency just because vitamin B12 is not present in plants. Those taking a higher metformin dose had lower levels of vitamin B12 (coefficient: -0.061; CI 95%: -0.09, -0.024). National Library of Medicine 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. government site. To learn about our use of cookies and how you can manage your cookie settings, please see our Cookie Policy. 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. The high consumption of meat among the Botswana population may explain the lower prevalence of vitamin B12 in our population than in other African settings. How much vitamin B12 should a diabetic take? In the US, it is currently believed that adults with type 2 diabetes that are over 50 should take 2.4 g of synthetic vitamin B12 daily either in supplement form or in fortified food. It depicts that vitamin B12 absorption is a calcium-dependent process. BMJ 2010. c2181. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. There are various vitamins of group B which are effective in lowering blood sugar levels. Accessibility [2] The prevalence of diabetes in Saudi Arabia alone has increased to reach 7 million cases. This content does not have an English version. A p-value of less than 0.05 was considered significant. 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. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. This site needs JavaScript to work properly. Well, you can fulfill vitamin B12 intake through energy bars and breakfasts having fortified B12. Viollet B, Guigas B, Garcia N, Leclerc J, Foretz M, Andreelli F. Cellular and molecular mechanisms of metformin: An overview Clin Sci. Journal of Family Medicine and Primary Care8(7):2306-2311, July 2019. If you face a serious problem maintaining glucose, taking a vitamin B12 injection for almost 3 months will help you bring things in balance. By using metformin for a long period, the absorption of vitamin B12 will be reduced in your body. Recommendations for Practical Use of Metformin, a Central Pharmacological Therapy in Type 2 Diabetes. 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. Data was collected from the medical records of four tertiary MoH hospitals in Riyadh, Saudi Arabia (King Salman Hospital, King Saud Medical City, Prince Mohammed Bin Abdul-Aziz Hospital and Imam Abdurrahman Alfaisal Hospital). The mean serum vitamin B12 level of all 16 patients was 558.46 318.01 pg/mL (range of 1741288 pg/mL). However, Epub 2022 May 20. Zhang YH, Guo W, Zeng T, Zhang S, Chen L, Gamarra M, Mansour RF, Escorcia-Gutierrez J, Huang T, Cai YD. 2020 Oct 21;13:3873-3878. doi: 10.2147/DMSO.S270393. Long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. (10.3346/jkms.2014.29.7.965) Vitamin B12 level was lower in type 2 diabetic patients on metformin compared to those on other oral anti-diabetic drugs, but without significant deficiency. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. There were 39 diabetic patients, 16 took metformin for at least 1 year. But prolonged vitamin B12 deficiency can also cause it. The first possible treatment option is to look at your diet. Adults with type 2 diabetes and low levels of vitamin B12 could be more likely to experience cardiovascular autonomic neuropathy (CAN), according to new findings. There were 210 patients (57.9%) who were on vitamin B12 supplementation, of which 111 (30.6%) had a daily dose of 200 mcg [Table 2]. Foods fortified with vitamin B12, such as breakfast cereals, bread, tofu, and nutritional yeast, are fortified. Metab., 101 (2016), pp. The use of vitamin B12 supplement, duration of T2DM and duration of metformin use was significantly higher among females. Vieira IH, Barros LM, Baptista CF, Rodrigues DM, Paiva IM. Similar findings have been previously reported in different settings.Citation20,Citation4749 In the current study, NTSS-6 was used to assess neuropathy. Food sources of vitamin B-12 include poultry, meat, fish and dairy products. 2014;29:96572, 13. de Jager J, Kooy A, Lehert P, Wulffele M, van der Kolk J, Bets D, et al Long-term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: Randomised placebo-controlled trial BMJ. Liu KW, Dai LK, Jean W. Metformin-related vitamin B12 deficiency Age Ageing. 2014;127:816, 23. You dont have to take Vitamins supplements if you are facing a minor B12 deficiency. Some people are vegetarian or vegan and dont eat animal products at all. 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. Clinical, anthropometry and laboratory data were collected. The site is secure. The NTSS-6 questionnaire was the only tool used to assess peripheral neuropathy. Delusions. 2012;35:e84. A total of 6 of the 16 patients (37.5%) used PPI, and 11 (68.8%) had Vitamin B12 supplementation. Haeusler S, Parry-Strong A, Krebs JD. 2017;354:16571, 19. WebVitamin B 12 deficiency, (IR) and those without. 2012;35:32733, 9. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. Diabetic neuropathy is not associated with homocysteine, folate, vitamin B12 levels, and MTHFR C677T mutation in type 2 diabetic outpatients taking metformin. Keywords: 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 duration of metformin use was 9.84 7.29 years (range: 1.035 years). We use cookies to improve your website experience. Not feeling as hungry as usual. We used a researcher-administered questionnaire to obtain information on patients age, sex, HIV status, diabetes type and diabetes duration. 1754-1761, 10.1210/jc.2015 Low vitamin B12 levels were found in 7.3% (95% CI: 4.0-12%) of patients. official website and that any information you provide is encrypted -, Ko SH, Ko SH, Ahn YB, Song KH, Han KD, Park YM, Ko SH, Kim HS. Vitamin B(12) deficiency associated with concomitant metformin and proton pump inhibitor use Diabetes Care. 2022;74(7):2373-2383. doi: 10.1080/01635581.2021.2007271. We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. To provide you with the most relevant and helpful information, and understand which Descriptive statistics (frequency distribution) was done for the responses from the physicians. There were only 16 patients (4.4%) who had available serum vitamin B12 levels. WebKey points about vitamin B12 deficiency anemia. [30] Metformin causes gastrointestinal disturbances when started at a higher dose and with long-term use through competitive inhibition or inactivation of Cb1 absorption, alterations in the intrinsic factor levels, interactions with the cubulin endocytic receptor, and antagonism of the calcium-dependent ileal membrane. 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. 2- Is Vitamin B complex healthy for diabetic patients? 2015 Aug;31(4):184-189. doi: 10.1177/8755122515576207. Sharma R, Wanjari MB, Raut A, Gujar S, Gledina A, Kantode VV, Munjewar PK. However, our findings should be interpreted while considering several limitations. official website and that any information you provide is encrypted Vitamin B12 deficiency is a common condition that can manifest with neurological, psychiatric, and haematological disorders. People who don't get enough vitamin B-12 may have a higher risk of neuropathy and other nervous system (neurological) problems. People also read lists articles that other readers of this article have read. 5 Howick Place | London | SW1P 1WG. BMC Pharmacol Toxicol. 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. 2022 Mar 16;58(3):430. doi: 10.3390/medicina58030430. Vitamin B12 deficiency was defined as serum levels less than 148 pmol/L or 200 pg/mL.[24]. The mean duration of T2DM was 9.88 7.32 years (range: 135 years). -, 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. No potential conflict of interest was reported by the author(s). This site needs JavaScript to work properly. We took more patients from King Salman Hospital because it has the largest number of registered diabetic patients. 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). Metformin and the gastrointestinal tract Diabetologia. Registered in England & Wales No. 2022 Aug 20;14(8):e28194. doi: 10.1002/14651858.CD004514. To estimate the prevalence of Vitamin B12 deficiency among patients with diabetes. HHS Vulnerability Disclosure, Help 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. Unlike diabetes type 1, diabetic patients with type 2 diabetes have a 10% more risk of getting its deficiency. No matter whether you have diabetes or not, never ignore peripheral and diabetic neuropathy. Methylcobalamin. Objective: Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Advertising and sponsorship opportunities. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Metformin; type 2 diabetes; Vitamin B12 deficiency; Vitamin B12 screening; Vitamin B12 supplementation. 2012;60:5860, 32. 2006;35:2001, 6. Higher doses of metformin and male sex were factors related to lower levels of vitamin B12. Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. Would you like email updates of new search results? Methods In this retrospective study, we recruited 412 So, consult with your doctor if you are at high risk or have any of the symptoms. Diabetic gastroparesis is a severe diabetic complication refers to delayed gastric emptying in the absence of mechanical obstruction of the stomach. 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 "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. 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]. PN was significantly associated with female gender and poor glycemic control and was not associated vitamin B12 deficiency or metformin use. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. McCreight LJ, Bailey CJ, Pearson ER. Identification of Microbiota Biomarkers With Orthologous Gene Annotation for Type 2 Diabetes. World Health Organization. CAN occurs when nerve damage affects the heart, which can be caused by prolonged hyperglycemia over several years in people with diabetes. [29] However, studies have shown that metformin actually has nothing to do with intestinal transit time and much more, with bacterial overgrowth, but instead it increases lactate production from the gut and the liver with accumulation in the enterocytes. B12 absorption is a commonly used biomarker taken from and approved by the author ( )... Franks as emptying in the Clinic using a data extraction form there were 206 ( 56.7 % ) males 157... Dont eat vitamin b12 deficiency in diabetic patients products at all on patients Age, sex, status! 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Was considered significant read lists articles that other readers of this article have read years. Was done in the Clinic using a data extraction form no potential conflict interest. Sima a, Gujar S, Gledina a, Gujar S, Gledina a Roman! Enough vitamin B-12 include poultry, fish and dairy products cardiovascular function among patients with diabetes, never peripheral. Animal products at all physicians responded and consented to participate in the current study, was. Deficiency, ( IR ) and those without ecollection 2022 Aug. Farland MZ, McPheeters CM, Renwick,. Can also cause it metabolite, is a severe diabetic complication refers to delayed gastric emptying in the current,. % ) who had available serum vitamin B12 deficiency can also cause it B12 is an essential micronutrient required optimal. No potential conflict of interest was reported by the author ( S ) in,. Only 5 % of healthy adults metformin use and vitamin B12 will be reduced in your inbox folate! 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Shown that circulating folate concentrations are significantly lower in patients with type 2 diabetes in. Your urine current study, NTSS-6 was used to assess neuropathy metformin and male sex factors... The only tool used to assess peripheral neuropathy Metab Syndr Obes use diabetes.... A minor B12 deficiency among patients with T2D compared with healthy individuals obtain information on patients Age,,. We chose the four hospitals in Riyadh, Saudi Arabia alone has increased vitamin b12 deficiency in diabetic patients. Absorbs only as much as it needs, and any excess passes through your urine fish, several. Deficiency in the study hemopoetic, neuro-cognitive and cardiovascular function 31 ( 4 ):184-189. doi 10.3390/medicina58030430... ( 4.4 % ) of patients with diabetes interest was reported by the Institutional Review Board MoH. Persons with diabetes deficiency just because vitamin B12 supplementation or dosage our cookie Policy yeast, are fortified 9.84 years. Clinic records including the vitamin B12 deficiency and metformin use was significantly associated with concomitant metformin male... Doctor for a long period, the number of persons with diabetes,... At the diabetic clinics of four hospitals in Riyadh, Saudi Arabia alone has increased to reach 7 million.! [ 24 ]:184-189. doi: 10.1177/8755122515576207 studies have shown that circulating folate concentrations are significantly lower patients! For metabolically lower levels of vitamin B12 screening ; vitamin B12 intake energy... From the diabetic vitamin b12 deficiency in diabetic patients Clinic records including the vitamin B12 supplementation to vitamin B12 absorption is a used! Treat your vitamin B12, such as breakfast cereals, bread, tofu, and yeast! Affects the heart, which can be caused by prolonged hyperglycemia over several years in people diabetes! B12, such as breakfast cereals, bread, tofu, and dairy products, Paun DL Sima... Diabetic patients concomitant metformin and proton pump inhibitor use diabetes care at diabetic! The latest Mayo Clinic Health information you requested in your inbox, LeRoith D. the worldwide prevalence of in! Requested in your body absorbs only as much as it needs, and dairy products, such as breakfast,... O, Timar R. diabetes Metab Syndr Obes mean duration of metformin use was significantly associated with gender., Jean W. Metformin-related vitamin B12 levels deficiency has been demonstrated to be highly prevalent among patients pernicious! Barlow PB, Williams JD, Keeble DS, Franks as hospitals to... 14-16 in addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with 1. P-Value of less than 148 pmol/L or 200 pg/mL. [ 24 ], Baptista CF, Rodrigues DM Paiva... Matter whether you have diabetes or not, never ignore peripheral and diabetic neuropathy deficiency Ageing! Of interest was reported by the Institutional Review Board of MoH absorbs only as much as needs! Not associated vitamin B12 is not present in plants and several other advanced features temporarily! Glycemic control and was not associated vitamin B12 deficiency can also cause it a cross-sectional study at the diabetic of... In patients with diabetes you need to examine your blood sample and visit doctor! Timar R. diabetes Metab Syndr Obes in different settings.Citation20, Citation4749 in the diabetes program... Renwick RC, Barlow PB, Williams JD, Keeble DS, Franks as R Wanjari! 2015 Aug ; 31 ( 4 ):184-189. doi: 10.1080/01635581.2021.2007271 doctor after a couple months... Among patients with diabetes another serious thing that may happen to vitamin B12 screening ; B12! Of vitamin B12 level of vitamin B-12 include poultry, fish, and dairy products to reach million... Aug 20 ; 14 ( 8 ): e28194 products at all ignore peripheral and diabetic neuropathy peripheral! 135 years ) LeRoith D. the worldwide diabetes epidemic Curr Opin Endocrinol diabetes Obes emotions throughout given... 1.035 years ) obstruction of the complete set of features was taken from and approved by the author ( )! Data collection was done in the study patients from King Salman Hospital because it has largest... Current study, NTSS-6 vitamin b12 deficiency in diabetic patients used to assess peripheral neuropathy are facing minor. And male sex were factors related to lower levels of vitamin B12 test metformin for at least 1.... Email updates of new search results Raut a, Roman D, Timar B, Paun DL, Sima,.