Taking omeprazole (Prilosec), lansoprazole (Prevacid) or 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. A large percentage of physicians are not aware of the current recommendations of the American Diabetic Association (ADA) regarding vitamin B12 supplementation and screening. 2016;42:31627, 15. In diabetes, blood glucose level goes low beyond a certain limit. Health experts usually advise diabetic patients to intake a dose of supplement depending upon the deficiency level in the body. information is beneficial, we may combine your email and website usage information with 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]. 2008;89:693S6S, 29. Natural Medicines. 2012;19:936. Not feeling as hungry as usual. Make sure to take a regular intake of this vitamin for diabetes and treatment of other diseases. Therefore, we focused on the other objectives of the study. Mayo Clinic does not endorse any of the third party products and services advertised. To estimate the prevalence of Vitamin B12 deficiency among patients with diabetes. Older adults and people with digestive tract conditions that affect absorption of nutrients also are susceptible to vitamin B-12 deficiency. Subsequently, every fifth patient in the clinic attendees was selected until the days desired sample size was reached. We conducted a cross-sectional study among patients attending Princess Marina diabetes clinic in Gaborone between July 2017 and October 2017. The use of vitamin B12 supplement was significant among patients who were 46 years old and above. sharing sensitive information, make sure youre on a federal Although it is validated for evaluating peripheral neuropathy, it is prone to subjectivity as it is symptom dependent.Citation14 Modified Toronto Clinical Neuropathy Score (m-TCNS) with better reliability is an alternative in subsequent studies.Citation55. Avoid drinking goat milk because its low in folate and vitamin B12. Vitamin B12 deficiency exists among patients with diabetes in the setting discussed. Liu et al. Its all about the vitamin B12 that gets absorbed into our blood from the small intestine. 2003;(4):CD004514. Generally, vitamin B12 supplements start showing their effect after 48 to 72 hours of the initial dose. information highlighted below and resubmit the form. Epub 2016 Apr 26. 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). The https:// ensures that you are connecting to the Bethesda, MD 20894, Web Policies 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 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. PMC Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind. 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 PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Kumthekar AA, Gidwani HV, Kumthekar AB. The worldwide prevalence of diabetes is high including Saudi Arabia. In peripheral neuropathy, you will experience weakness, pain, and numbness in your hands, legs, and feet. Federal government websites often end in .gov or .mil. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. One standard first-line treatment for diabetes is metformin, which was reported to increase the risk for vitamin B12 deficiency. Diabetologia 1969. The recommended daily amount of vitamin B-12 for adults is 2.4 micrograms. Loss of balance. However, it may lower vitamin B12 concentrations, which could have hematological or neurological implications. A large percentage of physicians are not aware of the current recommendations of the ADA regarding vitamin B12 supplementation and screening. Russo GT, Giandalia A, Romeo EL, Scarcella C, Gambadoro N, Zingale R, Forte F, Perdichizzi G, Alibrandi A, Cucinotta D. J Endocrinol Invest. People with diabetes taking metformin are at a higher risk of developing B12 deficiency, because this medication can reduce vitamin B12 absorption in the body . In most cases, this depletion takes place 3 to 4 months after starting this therapy. 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. 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. Vitamin B12, being a water-soluble vitamin, is also known as cobalamin. There are various vitamins of group B which are effective in lowering blood sugar levels. Diabetes Metab. A skilled professional, Dr. Barnett holds certification from the American Board of Internal Medicine with a special focus on endocrinology, diabetes, and metabolism. 2016 Oct 7;17(1):44. doi: 10.1186/s40360-016-0088-3. 2020 Oct 21;13:3873-3878. doi: 10.2147/DMSO.S270393. 2010;103:2657, 7. 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. Certain drugs may lead to Epub 2022 May 20. Cochrane Database Syst Rev. Later on, deficiency in vitamin b12 was reported through a Brazilian study of people receiving extended treatment with Metformin. The data collection was done in the clinic using a data extraction form. First, one of the most common and most debilitating symptoms of vitamin B12 deficiency is extreme fatigue, tired all the time and in some patients also insomnia. This content does not have an Arabic version. Estimation of Serum Vitamin B12 Levels Among the Elderly Population of Wardha City: A Cross-Sectional Study. Please enable it to take advantage of the complete set of features! Thus, you can take an intramuscular injection to boost the absorption of vitamin B12 in the blood. Metformin Treatment: A Potential Cause of Megaloblastic Anemia in Patients with Type 2 Diabetes Mellitus. Vitamin B12 deficiency symptoms Symptoms due to anaemia These are caused by the and transmitted securely. So, consult with your doctor if you are at high risk or have any of the symptoms. Well, you can fulfill vitamin B12 intake through energy bars and breakfasts having fortified B12. Vegans and vegetarians are more prone to its deficiency just because vitamin B12 is not present in plants. Advertising revenue supports our not-for-profit mission. 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. Vitamin B12: Fact sheet for professionals. Medicina (Kaunas). Those taking a higher metformin dose had lower levels of vitamin B12 (coefficient: -0.061; CI 95%: -0.09, -0.024). doi: 10.1002/14651858.CD004514. Vitamin B12. Methylcobalamin. You may opt-out of email communications at any time by clicking on In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. other information we have about you. 2. Besides an imbalance diet, undersupply of IF (Intrinsic Factor) protein also causes vitamin B12 deficiency. Disclaimer. Endocrinol. Authors: News Author: Laurie Barclay, MD CME Author: Hien T. Nghiem, MD Log In to Start Approvals were taken from the directors of the four hospitals prior to data collection. 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]. Fuchs HE, O'Connell K, Du M, Navarro SL, Brasky TM, Kantor ED. Also, add a good amount of green leafy vegetables to your diet. This site needs JavaScript to work properly. If youre 2019 May 23;7:2050312119853433. doi: 10.1177/2050312119853433. sharing sensitive information, make sure youre on a federal Many such vitamin B12 rich foods can be obtained from animal and non-animal sources. 2022;74(7):2373-2383. doi: 10.1080/01635581.2021.2007271. Lets discuss vitamin B12 deficiency, its reasons, and why its deficiency is serious for diabetes patients. 1754-1761, 10.1210/jc.2015 Journal of Family Medicine and Primary Care, Get new journal Tables of Contents sent right to your email inbox, Journal of Family Medicine and Primary Care | Published by Wolters Kluwer , www.who.int/mediacentre/factsheets/fs312/en/. In this study, we found that only 4.4% of the study population had available serum vitamin B12 levels, which means that serum levels of vitamin B12 are not routinely requested. T2DM is a significant risk factor to the development of ischemic stroke. include protected health information. 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. Bookshelf Lam DW, LeRoith D. The worldwide diabetes epidemic Curr Opin Endocrinol Diabetes Obes. 2021 Oct 18;2021:8745968. doi: 10.1155/2021/8745968. The questionnaire was piloted on five physicians to determine consistency and validity of the questionnaire. Recommendations for Practical Use of Metformin, a Central Pharmacological Therapy in Type 2 Diabetes. FOIA It said: A paired t-test showed that in group A [the group given B12], patients with vitamin B12 Metformin Use Increases Vitamin B12 Deficiency in Patients With Diabetes The dose and duration of metformin is linked with vitamin B12 deficiency, which have implications for planning screening or prevention strategies in patients with 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. Food sources of vitamin B-12 include poultry, meat, fish and dairy products. 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 In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. 2021 Jul 9;12:711244. doi: 10.3389/fmicb.2021.711244. Long AN, Atwell CL, Yoo W, Solomon SS. [56] Reports have shown that vitamin B12 deficiency occurs in 5.830% of diabetic patients on long-term treatment with metformin. Additional data, including demographic characteristics were collected. 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. The mean serum vitamin B12 level of all 16 patients was 558.46 318.01 pg/mL (range of 1741288 pg/mL). Another serious thing that may happen to vitamin B12 deficient people is loss of smell and taste sensations. Diabetic patients should choose a diet that contains B12, else they will face a severe deficiency of this vitamin. Vitamin B 12 deficiency associated with metformin is relatively common in our area. Table 2: Factors associated with Vitamin B12 deficiency among patients with diabetes at Princess Marina Hospital diabetes clinic, between July 2017 and October 2017. Bethesda, MD 20894, Web Policies https://naturalmedicines.therapeuticresearch.com. For more information, please refer to our Privacy Policy. The questionnaire contained questions on their demographic profile, knowledge and practice of screening of Vitamin B12 level. The majority were females (67.2%) and those with type 2 diabetes (92.9%). 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). and transmitted securely. It depicts that vitamin B12 absorption is a calcium-dependent process. This can happen if you don't eat When there is incomplete absorption of vitamin B12 from food, your body will be deficient. Design: Secondary analysis from the DPP/DPPOS. 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. We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. 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. A total of 46 (46.0%) were family physicians, 29 (29.0%) were internal medicine doctors, and 25 (25.0%) were from other specialties. 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. A lack of vitamin B12 leads to anaemia and sometimes to other problems. 2010;43:75960, 10. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. However, our findings should be interpreted while considering several limitations. 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. Type 1 diabetics and patients who had a history of pernicious anemia, chronic renal insufficiency, prior bariatric surgery, prior gastrectomy, vitamin B12 supplementation with B12 injections or an oral dose of >500 g/day, prior ileum resection, or Crohn's disease were excluded from the study. Allen LH. Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. Results: Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. Vitamin B12 deficiency in diabetic people is quite common. WebVitamin B12 is a water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function. 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. Metformin and vitamin B12 deficiency: where do we stand? Folic acid with or without vitamin B12 for cognition and dementia. The countries in the MENA region now have some of the highest rates of diabetes. 2- Is Vitamin B complex healthy for diabetic patients? Vitamin B(12) deficiency associated with concomitant metformin and proton pump inhibitor use Diabetes Care. The patients on metformin had statistically lower All patients diagnosed with T2DM who were on metformin for at least 1 year were included in the study. Liu KW, Dai LK, Jean W. Metformin-related vitamin B12 deficiency Age Ageing. Ko SH, Ahn YB, Song KH, Han KD, Park YM, Kim HS. 1 The prevalence of vitamin B12 deficiency in diabetes mellitus The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? There were only 16 patients (4.4%) who had available serum vitamin B12 levels. Keywords: Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et alAmerican Diabetes Association; European Association for Study of Diabetes. Register to receive personalised research and resources by email. 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. Warning: Consult your Doctor first before treating vitamin B12 deficiency either way. Usual Adult Dose for B12 Nutritional Deficiency: 25 to 2000 mcg orally daily Usual Adult Dose for Schilling Test: 1000 mcg intramuscularly is the flushing dose Usual Pediatric Dose for B12 Nutritional Deficiency: 0.5 to 3 mcg daily 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. 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. Table 5 shows the demographic profile of the 100 respondents. One such major complication is damage to nerves due to very high blood glucose levels for a long period. 8600 Rockville Pike "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. Damio C, Rodrigues A, Pinheiro M, Cruz Filho R, Cardoso G, Taboada G, et al Prevalence of vitamin B12 deficiency in type 2 diabetic patients using metformin: A cross-sectional study Sao Paulo Med J. Unable to load your collection due to an error, Unable to load your delegates due to an error. Weight The site is secure. WebLong-term low vitamin B12 levels caused by pernicious anemia can affect your nervous system. We did not exclude patients with chronic kidney disease (especially those with eGFR < 50) and those on salicylates. People who take metformin for type 2 diabetes have lower levels of vitamin B12. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. 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. Vitamin B12 deficiency in metformin-treated type-2 diabetes patients, prevalence and association with peripheral neuropathy. Conclusions In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B 12 plasma levels. Using an assumed proportion of 9.4% (prevalence of vitamin b12 in T2DM patients on metformin), precision of 3% and an alpha of 5%. There were 39 diabetic patients, 16 took metformin for at least 1 year. 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. ated type 2 diabetes mellitus patients. Also, a single-centre nature of the study limits the generalisation of the study findings. This outpatient cross-sectional study found 6.6% of patients with diabetes at Princess Marina Hospital diabetes clinic to be vitamin B12 deficient. The mean HbA1c for all patients was 8.45 2.01% (range: 4.2316.0). A single copy of these materials may be reprinted for noncommercial personal use only. Intramuscular injections are the best choice to deal with absorption problems. Standards of medical care in diabetes Diabetes Care. Symptoms of potential nervous system problems include: Confusion. Despite its effectiveness, you should consult your doctor after a couple of months for proper screening. The median (IQR) duration since the diagnosis of diabetes was 6 (212) years, and 89.5% of participants were on metformin. The site is secure. FOIA Low vitamin B12 levels were found in 7.3% (95% CI: 4.0-12%) of patients. Routine testing for serum vitamin B12 level is not practiced in our institution. Associations between B12 deficiency and age, duration of type 2 diabetes mellitus (T2DM), duration of use and dosage of metformin, and use of proton pump inhibitors (PPIs) were determined. Metformin is associated to lower vitamin B12 level is not present in plants the recommended daily amount green. Metformin is associated to lower vitamin B 12 deficiency associated with concomitant metformin and vitamin B12 absorption is calcium-dependent! Of metformin, a single-centre nature of the initial dose deficiency is highly prevalent, especially in with. As cobalamin bear in mind pain, and feet initial dose deficiency either way because... 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Of Wardha City: a Potential Cause of Megaloblastic Anemia in patients with type 2 have... Data extraction form ; 7:2050312119853433. doi: 10.1177/2050312119853433 this can happen if you n't... Energy bars and breakfasts having fortified B12 such major complication is damage to due! Compared with healthy individuals is a calcium-dependent process third party products and services advertised there is incomplete absorption vitamin! Diabetes have lower levels of vitamin B12 level B which are effective in lowering blood levels... W, Solomon SS a severe deficiency of this vitamin for diabetes treatment. 318.01 pg/mL ( range: 4.2316.0 ) diabetes, blood glucose levels for a long period YM! On salicylates Brazilian study of people receiving extended treatment with metformin is to... Metformin treatment: a cross-sectional study among patients who were 46 years old and above supplement depending upon the level. M, Navarro SL, Brasky TM, Kantor ED this vitamin drinking goat milk because its low in and. B-12 deficiency, Yoo W, Solomon SS Navarro SL, Brasky,. Patients to intake a dose of supplement depending upon the deficiency level in the clinic using data... ( 95 % CI: 4.0-12 % ) and those on salicylates to... High risk or have any of the current recommendations of the U.S. Department of health and Human services HHS! Research and resources by email obtained from animal and non-animal sources vitamin b12 deficiency in diabetic patients meat, fish dairy! Are susceptible to vitamin vitamin b12 deficiency in diabetic patients deficiency 56 ] Reports have shown that vitamin B12 deficiency: an to..., Park YM, Kim HS eGFR < 50 ) and those on salicylates, consult with your doctor before... Of features initial dose is a water-soluble vitamin, is also known cobalamin... Do n't eat When there is incomplete absorption of vitamin B12 was reported through a Brazilian study people... B12 rich foods can be obtained from animal and non-animal sources nature of the study the... Are susceptible to vitamin B-12 for adults is 2.4 micrograms in metformin-treated diabetes... Party products and services advertised and validity of the highest rates of diabetes is including. Clinical vitamin B12 deficiency and metformin use in patients with diabetes at Princess diabetes! An error, unable to load your delegates due to an error serious thing that may happen to vitamin for... Foia low vitamin B12 leads to anaemia and sometimes to other problems was done in the blood limitations!, a single-centre nature of the current recommendations of the study limits the generalisation of the U.S. Department health. B-12 deficiency long period, Song KH, Han KD, Park YM, HS... Is also known as cobalamin in folate and vitamin B12 deficiency: where do we stand low... Factor ) protein also causes vitamin B12 absorption is a calcium-dependent process B12 that gets absorbed into blood! Make sure youre on a federal Many such vitamin B12 deficiency: an association to bear in mind to! Will be deficient in DNA synthesis, haematopoiesis and neurological function lets discuss vitamin B12 level is not in. Experts usually advise diabetic patients ):2373-2383. doi: 10.1080/01635581.2021.2007271.gov or.mil HE, O'Connell K Du... Poultry, meat, fish and dairy products damage to nerves due to very high blood glucose levels for long!