ASSOCIATION OF VITAMIN B12 DEFICIENCY WITH INTAKE OF ORAL METFORMIN IN DIABETIC PATIENTS

Najam Ul Hasan, Mujeeb Ullah Makki, Izza Abid, Mujeeb Ur Rehman Abid Butt

Abstract


Background: It is estimated that 450 million people worldwide have diabetes mellitus Objective of the study was to determine effect of Metformin on vitamin B12 level among patients with type 2 diabetes mellitus. It is a cross sectional study conducted at Medicine department, Shalamar Hospital Lahore. Methods: Seventy-two patients of diabetes mellitus were included in the study. All patients who could have any other disease process that can lead to Vitamin B12 deficiency were excluded from the study. They were segregated into two groups, first one was getting metformin for the last 2 years and the second group was not taking metformin. Vitamin B12 levels were checked in all the patients and value of 150pmol/L was taken as normal. Results: Out of 72 patients who participated in our study, 40 patients (55.5%) were taking metformin for more than two years while 32 patients (44.5%) were not taking metformin for the last two years. Mean age of patients taking metformin and not taking metformin was 59±9.12 years and 60±5.47 years respectively. Mean vitamin B12 level was 360±185.2 pg/ml in patients taking metformin while among non-metformin group mean vitamin B12 level was 619±176 pg/ml (p value=0.0001). Furthermore, HbA1c and MCV were significantly different among metformin group and non-metformin group, i.e., p=0.034 and 0.039 respectively. Among metformin group, age and MCV were also significantly different in those having vitamin B12 deficiency and those having normal Vitamin B12 levels, i.e., p=0.042 and 0.001 respectively. Conclusion: It was concluded from our study that long term (>2 years) use of metformin is significantly associated with vitamin B12 deficiency.

Keywords: Metformin; Vitmain B12, Diabetes, HbA1c


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References


American Diabetes Association. Standards of medical care in diabetes 2010. Diabetes Care 2010;33(Suppl 1):11–61.

IDF Diabetes Atlas Update Poster, 7th ed. International Diabetes Federation, Brussels, Belgium; 2015.

Shera AS, Jawad F, Maqsood A. Prevalence of diabetes in Pakistan. Diabetes Res Clin Pract 2007;76(2):219–22.

DeFronzo R, Fleming GA, Chen K, Bicsak TA. Metformin-associated lactic acidosis: Current perspectives on causes and risk. Metabolism 2016;65(2):20–9.

Ko SH, Ko SH, Ahn YB, Song KH, Han KD, Park YM, et al. Association of Vitamin B12 Deficiency and Metformin Use in Patients with Type 2 Diabetes. J Korean Med Sci 2014;29(7):965–72.

Iftkhar R, Kamran SM, Qadir A, Iqbal Z, Usman HB. Prevalence of Vitamin B12 deficiency in patients of type 2 diabetes mellitus on metformin: a case control study from Pakistan. Pan Afr Med J 2013;16:67.

Marar O, Senturk S, Agha A, Thompson C, Smith D. Prevalence of Vitamin B12 deficiency in patients with type 2 diabetes mellitus on metformin. Royal Coll Surg Ireland Stud Med J 2011;4(1):16–20.

Ahmed MA, Muntingh G, Rheeder P. Vitamin B12 deficiency in metformin-treated type-2 diabetes patients, prevalence and association with peripheral neuropathy. BMC Pharmacol Toxicol 2016:17(1):44.

Nervo M, Lubini A, Raimundo FV, Faulhaber GA, Leite C, Fischer LM, et al. Vitamin B12 in metformin treated diabetic patients, a cross-sectional study in Brazil. Rev Assoc Med Bras (1992) 2011;57(1):46–9.

Filioussi K, Bonvoas S, Katsaros T. Should we screen diabetes patients using biguanides for megaloblastic anaemia. Aust Fam Physician 2003;32(5):383–4.

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 2013;71(7):386–90.

Kang D, Yun JS, Ko SH, Lim TS, Ahn YB, Park YM, et al. Higher prevalence of metformin-induced vitamin B12 deficiency in sulfonylurea combination compared with insulin combination in patients with type 2 diabetes: a cross-sectional study. PLoS One 2014;9(10):e109878.

Khan A, Shafiq I, Shah MH. Prevalence of Vitamin B12 Deficiency in Patients with Type II Diabetes Mellitus on Metformin: A Study from Khyber Pakhtunkhwa. Cureus 2017;9(8):e1577.

Liu KW, Dai DLK, Lau E, Woo J. Metformin-associated vitamin B12 deficiency in the elderly. Asian J Gerontol Geriatr 2011;6(2):82–7.


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