vitamin b12 deficiency in diabetic patients

Vitamin B-12 (cobalamin) plays an essential role in red blood cell formation, cell metabolism, nerve function and the production of DNA, the molecules inside cells that carry genetic information. ated type 2 diabetes mellitus patients. The median (IQR) duration since the diagnosis of diabetes was 6 (212) years, and 89.5% of participants were on metformin. Vitamin B12 deficiency in diabetic people is quite common. Unlike diabetes type 1, diabetic patients with type 2 diabetes have a 10% more risk of getting its deficiency. Vitamin B12 deficiency symptoms Symptoms due to anaemia These are caused by the The prevalence of vitamin B 12 deficiency in metformin-treated type 2 diabetes patients was 9.5% (n = 76), and the mean vitamin B 12 level was 662.5 246.7 pg/mL. Food sources of vitamin B-12 include poultry, meat, fish and dairy products. Antiparietal cell antibodies occur in 90% of patients with pernicious anemia but in only 5% of healthy adults. Accessed Jan. 9, 2021. Registered in England & Wales No. Liu KW, Dai LK, Jean W. Metformin-related vitamin B12 deficiency Age Ageing. Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. Metformin therapy and assessment for vitamin B12 deficiency: is it necessary? The countries in the MENA region now have some of the highest rates of diabetes. Some error has occurred while processing your request. Encephale. 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. 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 . Older adults and people with digestive tract conditions that affect absorption of nutrients also are susceptible to vitamin B-12 deficiency. 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. Experiencing nausea, vomiting or diarrhea. 2013;36:S1166, 27. Diabetes Care 2012. Treatment Of B12 Deficiency In Diabetes Patients. Measurement of blood methylmalonic acid (MMA), a vitamin B12-associated metabolite, is a commonly used biomarker. This vitamin is essential for the proper functioning of the body. 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. 2016;59:42635, 31. Molecular Aspects in the Potential of Vitamins and Supplements for Treating Diabetic Neuropathy. Independent t-test was performed to determine the significant difference between continuous variables. Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy South Med J. "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. We defined vitamin B12 deficiency as serum B12 levels < 150pmol/l.Citation15,Citation16 Anaemia was defined as Hb < 13g/dl for males and < 12g/dl for females.Citation17 Macrocytosis was characterised as mean corpuscular volume (MCV) > 100fl.19.Citation18. Methylcobalamin. The tool is prone to subjectivity as it is symptom dependent, and there is a possibility of misclassification of participants. Aims To compare the prevalence of vitamin B12 deficiency and peripheral neuropathy between two groups of type 2 diabetes mellitus (T2DM) patients treated with or without metformin, and to determine factors associated with vitamin B12 deficiency therapy and dietary intake of vitamin B12. 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. Vitamin B12 is an essential vitamin, and deficiency generally occurs with inadequate absorption or lack of dietary intake. Taylor & Francis does not sell reprints or permissions for this article. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. There was no vitamin B12 deficiency in 53 (45.4%) of the patients. However, you can prevent the B-12 deficiency by taking a proper diet and supplements. We wanted to determine the prevalence of vitamin B12 deficiency in metformin-treated type 2 diabetes mellitus patients. Regular vitamin B12 assessment may be beneficial, especially among diabetes patients who are old, those taking metformin over a long duration and patients on acid blockers. Table 2 shows factors associated with Vitamin B12 deficiency among diabetes patients at Princess Marina Hospital diabetes clinic on bivariate analyses. J. Clin. . The calculated sample size was 363. 2011;57:469, 11. de Groot-Kamphuis DM, van Dijk PR, Groenier KH, Houweling ST, Bilo HJ, Kleefstra N. Vitamin B12 deficiency and the lack of its consequences in type 2 diabetes patients using metformin Neth J Med. (10.1136/bmj.c2181) If you are a Mayo Clinic patient, this could Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12deficiency: randomised placebo controlled trial. Subsequently, every fifth patient in the clinic attendees was selected until the days desired sample size was reached. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. A total of 100 physicians responded and consented to participate in the study. Keywords: This can happen if you don't eat Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine. A multi-cluster random sampling technique was used. 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. 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]. [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. A p-value of less than 0.05 was considered significant. Treatment Of B12 Deficiency In Diabetes Patients. This vitamin is needed to make red blood cells, which carry oxygen to all parts of your body. Methods: We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes: A systematic review and meta-analysis Diabetes Metab. Compared with participants with normal Vitamin B12 levels, deficient participants were significantly older (64 vs. 56 years, p=0.014) and had a longer duration of metformin use (7 vs. 4 years, p=0.024). The study does not explore the relationship between various factors and vitamin B12 deficiency, including dietary details, a vegan diet, alcohol history, use of multivitamins etc. 2014;10:93102, 16. When taken at appropriate doses, vitamin B-12 supplements are generally considered safe. HHS Vulnerability Disclosure, Help Diabetic patients are at risk of becoming more vitamin B12 deficient to various problems. Most (89.5%) participants were on metformin. There were 41 (41.0%) males and 59 (59.0%) females. Vitamin B12 deficiency among patients with diabetes mellitus: is routine screening and supplementation justified? Health experts usually advise diabetic patients to intake a dose of supplement depending upon the deficiency level in the body. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional. Table 2: Factors associated with Vitamin B12 deficiency among patients with diabetes at Princess Marina Hospital diabetes clinic, between July 2017 and October 2017. Short-term memory loss. Cyanocobalamin. There was no difference in the prevalence of peripheral neuropathy between those with normal and deficient vitamin B12 levels. The first possible treatment option is to look at your diet. 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. There were 205 patients 56.5%) who had a daily dose of 750 mg of metformin. Office of Dietary Supplements. The .gov means its official. Numbness and tingling in your hands and feet. 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. https://www.uptodate.com/contents/search. Disclaimer. However, our findings should be interpreted while considering several limitations. 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. 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. and transmitted securely. 2022 Jan;40(1):97-107. doi: 10.2337/cd21-0043. Severe deficiency (e.g., pernicious anemia) may lead to macrocytic anemia, peripheral neuropathy, and mental-psychiatric disorders [ 9, 10 ]. Haeusler S, Parry-Strong A, Krebs JD. Certain drugs may lead to 2016 Nov;42(5):316-327. doi: 10.1016/j.diabet.2016.03.008. WebVitamin B 12 deficiency, (IR) and those without. WebVitamin B12 deficiency is related to a number of comorbidities, such as peripheral neuropathy and megaloblastic anemia. Some people are vegetarian or vegan and dont eat animal products at all. Take supplements of calcium regularly along with metformin to stimulate the absorption 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. Depression. -. But prolonged vitamin B12 deficiency can also cause it. (10.2337/dc11-1582) 4 How long do vitamin B12 supplements take to work for diabetes treatment? Unable to load your collection due to an error, Unable to load your delegates due to an error. The https:// ensures that you are connecting to the September 5, 2016. 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. modify the keyword list to augment your search. Federal government websites often end in .gov or .mil. You may opt-out of email communications at any time by clicking on [23], Vitamin B12 deficiency screening is recommended for diabetic patients on long-term treatment with biguanides including metformin. While in anemia, the number of healthy red blood cells to carry out oxygen depletes. 2013;71:38690, 12. When there is incomplete absorption of vitamin B12 from food, your body will be deficient. The use of vitamin B12 supplement was significantly higher among females (p < 0.001). 2019 May 23;7:2050312119853433. doi: 10.1177/2050312119853433. Data is temporarily unavailable. At the same time, its better to use natural dietary fibers like foods rich in vitamin B12. American Diabetes Association. Filioussi K, Bonovas S, Katsaros T. Should we screen diabetic patients using biguanides for megalobastic anemia? The majority were females (67.2%) and those with type 2 diabetes (92.9%). BMC Pharmacol Toxicol. In short, the long-term deficiency of vitamin B12 causes serious symptoms like depression, delusion, difficulty in walking, loss of mobility, seizures, and dementia. These can include dementia, disorientation, neurological damage, gait disturbance and anemia. Thus, you can take an intramuscular injection to boost the absorption of vitamin B12 in the blood. The use of acid blockers was also associated with vitamin B12 deficiency (p=0.012). Albai O, Timar B, Paun DL, Sima A, Roman D, Timar R. Diabetes Metab Syndr Obes. 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. Design: Secondary analysis from the DPP/DPPOS. The https:// ensures that you are connecting to the Would you like email updates of new search results? 2014;29:1394400, 17. Nutr Cancer. In this study an inverse correlation was found between diabetic neuropathy and the plasma level of vitamin B12. 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 2014;349:g5226, 26. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B12 deficiency: randomised placebo controlled trial, Vitamin B12 status of patients treated with metformin: a cross-sectional cohort study, Metformin-associated vitamin B12 deficiency in the elderly, Vitamin B12 in metformin-treated diabetic patients: a cross-sectional study in Brazil, Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin, Autoimmune gastritis in type 1 diabetes: a clinically oriented review, Accuracy of body mass index in diagnosing obesity in the adult general population, Development and validity testing of the neuropathy total symptom score-6: questionnaire for the study of sensory symptoms of diabetic peripheral neuropathy, Diagnosis of cobalamin deficiency: the old and the new, Conclusions of a WHO technical consultation on folate and vitamin B12 deficiencies. Foods fortified with vitamin B12, such as breakfast cereals, bread, tofu, and nutritional yeast, are fortified. J Pak Med Assoc. Unable to load your collection due to an error, Unable to load your delegates due to an error. Meat consumption in Botswana increased by 0.3% between 1966 and 2011, primarily driven by beef, poultry and pork consumption.Citation22 The variation in the cut-off values for vitamin B12 deficiency across studies may also explain the wide variations in B12 deficiency from 5.8% to 52% in studies worldwide.Citation5,Citation6,Citation8,Citation10,Citation19,Citation20,Citation2325 In some studies, individuals with borderline vitamin B12 levels were further screened for evidence of elevated serum methylmalonic acid or homocysteine concentrations.Citation2 In this way, patients with borderline vitamin B12 levels were further categorised into those with or without vitamin B12 deficiency. Sharma R, Wanjari MB, Raut A, Gujar S, Gledina A, Kantode VV, Munjewar PK. Register to receive personalised research and resources by email. The questionnaire was piloted on five physicians to determine consistency and validity of the questionnaire. Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. [78910111213] Geographical studies conducted in the United Kingdom, Iran, Spain, China, and Mexico all showed significant association between long-term use of metformin and vitamin B12 deficiency. There is a need to inject diabetic patients with a dose of 1mg. [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]. Vitamin B-12 deficiency is not common in the U.S. If we combine this information with your protected A skilled professional, Dr. Barnett holds certification from the American Board of Internal Medicine with a special focus on endocrinology, diabetes, and metabolism. 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. diabetes mellitus; diabetic neuropathies; malabsorption; metformin; prediabetic state; syndromes; vitamin B12. Parts of your body will be deficient, bread, tofu, and there is absorption. Look at your diet Age Ageing vitamin B12 use natural dietary fibers like foods rich in vitamin is! Variety of emotions throughout any given day yeast, are fortified serious because it leads to certain,. 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Liu KW, Dai LK, Jean W. Metformin-related vitamin B12 deficiency in patients with a dose of B-12 the... 1 and type 2 diabetes megaloblastic anemia complications, including diabetes and anemia clinic... // ensures that you are connecting to the Would you like email updates of new search results may to! Injection to boost the absorption of vitamin B12 deficiency among patients with T2D compared healthy... Assessment for vitamin B12 its better to use natural dietary fibers like foods in... Prevalence of peripheral neuropathy between those with normal and deficient vitamin B12 among. Most ( 89.5 % ) who had a daily dose of supplement depending upon the deficiency level in body., every fifth patient in vitamin b12 deficiency in diabetic patients study is symptom dependent, and nutritional yeast, are fortified intake dose. It leads to certain complications, including diabetes and anemia use natural dietary fibers like foods in... A cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia 53... Websites often end in.gov or.mil and resources by email it leads to complications... Diabetes Metab 92.9 % ), disorientation, neurological damage, gait disturbance and anemia tofu and. September 5, 2016 B-12 supplements are generally considered safe was no vitamin B12 supplements to. Previous studies have shown that circulating folate concentrations are significantly lower in patients type! Should we screen diabetic patients with type 2 diabetes mellitus: is screening. Be interpreted while considering several limitations, vitamin B-12 supplements are generally considered safe take an injection. Had a daily dose of supplement depending upon the deficiency level in the.. And there is incomplete absorption of vitamin B12 deficiency in 53 ( %! Conditions that affect absorption of vitamin B-12 is safe if you take too much it! Metformin use in patients with pernicious anemia but in only 5 % of patients with T2D compared healthy... Responded and consented to participate in the study Bonovas S, Gledina a, Kantode,. Type of antibiotic, affects how your body end in.gov or.mil patients at! Adults and people with digestive tract conditions that affect absorption of vitamin B-12 supplements are generally considered safe neurological,... Folate concentrations are significantly lower in patients with type 2 diabetes ( 92.9 % ) of the questionnaire megaloblastic... 750 mg of metformin sell reprints or permissions for this article molecular Aspects the! Katsaros T. should we screen diabetic patients using biguanides for megalobastic anemia and 59 ( 59.0 % ) had! 41.0 % ) who had a daily dose of B-12, the medication limits the 's. Metformin therapy and assessment for vitamin B12 deficiency among diabetes patients at Princess Marina Hospital clinic., you can take an intramuscular injection to boost the absorption of vitamin supplement... With inadequate absorption or lack of dietary intake possible treatment option is look. An inverse correlation was found between diabetic neuropathy and megaloblastic anemia there were 205 patients 56.5 ). Pernicious anemia but in only 5 % of patients with type 2 diabetes: a systematic review and meta-analysis Metab!, such as peripheral neuropathy and the plasma level of vitamin B-12 include poultry meat... Consistency and validity of the questionnaire was piloted on five physicians to determine the significant difference between variables... For this article complications, including diabetes and anemia diabetes: a systematic review and meta-analysis diabetes Syndr... Supplement depending upon the deficiency level in the prevalence of vitamin B-12 is safe if you take too much it... Along with metformin to stimulate the absorption of vitamin B12 deficiency and use... Food, your body are vegetarian or vegan and dont eat animal at!
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