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vitamin b12 deficiency in diabetic patients
According to a study, almost 22% of people with diabetes were low in B-12, suggesting that metformin is the reason. 2014;10:93102, 16. Estimation of Serum Vitamin B12 Levels Among the Elderly Population of Wardha City: A Cross-Sectional Study. 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. Its not only the vitamin B12 that we intake orally. 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 Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. It said: A paired t-test showed that in group A [the group given B12], patients with vitamin B12 The majority were females (67.2%) and those with type 2 diabetes (92.9%). Methods: Intramuscular injections are the best choice to deal with absorption problems. (10.3346/jkms.2014.29.7.965) People who don't get enough vitamin B-12 may have a higher risk of neuropathy and other nervous system (neurological) problems. To provide you with the most relevant and helpful information, and understand which 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). Register to receive personalised research and resources by email. WebNo correlation was found between vitamin B 12 plasma levels and metformin treatment time or dosage. Among patients with type 2 diabetes (T2D), vitamin B 12 deficiency is common owing to medication interactions (eg, metformin) or malnutrition. 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. The .gov means its official. Keywords: Liu KW, Dai LK, Jean W. Metformin-related vitamin B12 deficiency Age Ageing. Its all about the vitamin B12 that gets absorbed into our blood from the small intestine. 14-16 In addition, previous studies have shown that circulating folate concentrations are significantly lower in patients with T2D compared with healthy individuals. 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. In this study an inverse correlation was found between diabetic neuropathy Some people are vegetarian or vegan and dont eat animal products at all. Journal of Korean Medical Science 2014. This site needs JavaScript to work properly. Foods fortified with vitamin B12, such as breakfast cereals, bread, tofu, and nutritional yeast, are fortified. diabetes mellitus; diabetic neuropathies; malabsorption; metformin; prediabetic state; syndromes; vitamin B12. 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. Vitamin B12 levels were checked in all the patients and value of 150 pmol/L was taken as normal. Your message has been successfully sent to your colleague. 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. Diabetic gastroparesis is a severe diabetic complication refers to delayed gastric emptying in the absence of mechanical obstruction of the stomach. Table 5 shows the demographic profile of the 100 respondents. [23], Vitamin B12 deficiency screening is recommended for diabetic patients on long-term treatment with biguanides including metformin. If you face a serious problem maintaining glucose, taking a vitamin B12 injection for almost 3 months will help you bring things in balance. Besides this, diabetic neuropathy will also affect the gastrointestinal tract of your body. Causes and pathophysiology of vitamin B12 and folate deficiencies. 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. The mean duration of T2DM was 9.88 7.32 years (range: 135 years). Using an assumed proportion of 9.4% (prevalence of vitamin b12 in T2DM patients on metformin), precision of 3% and an alpha of 5%. The mean duration of metformin use was 9.84 7.29 years (range: 1.035 years). Diabetologia 1969. Accessed Jan. 9, 2021. https://www.uptodate.com/contents/search. sharing sensitive information, make sure youre on a federal MeSH Treatment Of B12 Deficiency In Diabetes Patients. Diabetic neuropathy was evaluated by patient record, nerve conduction and Michigan test for the diagnosis of diabetic neuropathy. Several studies have unequivocally demonstrated that vitamin B12 deficiency is highly prevalent in adult diabetic patients [24]. information highlighted below and resubmit the form. Table 1: Baseline characteristics of patients with diabetes at Princess Marina hospital diabetes clinic, between July 2017 and October 2017 (n=351). The calculated sample size was 363. Subsequently, every fifth patient in the clinic attendees was selected until the days desired sample size was reached. Highlight selected keywords in the article text. The mean age of these 16 patients was 53.8 14.26 (range of 3584 years old). . 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. Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes: A systematic review and meta-analysis Diabetes Metab. There are various vitamins of group B which are effective in lowering blood sugar levels. 2016;59:42635, 31. J Pak Med Assoc. Depression. These symptoms are pain and numbness in the arms, legs, hands, and feet. When there is incomplete absorption of vitamin B12 from food, your body will be deficient. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. The most commonly used oral hypoglycemic agent was gliclizide only in 138 (38.4%) of patients. In diabetes, blood glucose level goes low beyond a certain limit. 2016;134:4739, 22. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. Al Dawish MA, Robert AA, Braham R, Al Hayek AA, Al Saeed A, Ahmed RA, et al Diabetes mellitus in Saudi Arabia: A review of the recent literature Curr Diabetes Rev. government site. Vitamin B12 deficiency is a common condition that can manifest with neurological, psychiatric, and haematological disorders. [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. The recommended daily amount of vitamin B-12 for adults is 2.4 micrograms. Higher doses of metformin and male sex were factors related to lower levels of vitamin B12. 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. WebVitamin B 12 deficiency, (IR) and those without. The use of acid blockers was also associated with vitamin B12 deficiency (p=0.012). 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. 1- Does vitamin B12 is crucial for lowering blood sugar? T2DM is a significant risk factor to the development of ischemic stroke. (10.2337/dc11-1582) PN was significantly associated with female gender and poor glycemic control and was not associated vitamin B12 deficiency or metformin use. Allen LH. https://www.micromedexsolutions.com. Diabetic neuropathy is not associated with homocysteine, folate, vitamin B12 levels, and MTHFR C677T mutation in type 2 diabetic outpatients taking metformin. Russo GT, Giandalia A, Romeo EL, Scarcella C, Gambadoro N, Zingale R, Forte F, Perdichizzi G, Alibrandi A, Cucinotta D. J Endocrinol Invest. When IF binds with Vitamin B12, a vitamin B12-IF complex forms, this complex plays a vital role in the absorption of vitamin B12 in your body. Unlike diabetes type 1, diabetic patients with type 2 diabetes have a 10% more risk of getting its deficiency. Sharma R, Wanjari MB, Raut A, Gujar S, Gledina A, Kantode VV, Munjewar PK. Of all the patients 17 were already considered to be deficient in B12. There were only 16 patients (4.4%) who had available serum vitamin B12 levels. 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. 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. Bethesda, MD 20894, Web Policies [56] Reports have shown that vitamin B12 deficiency occurs in 5.830% of diabetic patients on long-term treatment with metformin. Vitamin B12 deficiency resulting from metformin use has been demonstrated in multiple studies. Office of Dietary Supplements. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. Proton pump inhibitors. Unauthorized use of these marks is strictly prohibited. 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). 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). This can happen if you don't eat [28] Type 2 diabetics particularly those on metformin are at risk for metabolically lower levels of vitamin B12. WebConclusion: Among patients with type 2 diabetes using metformin, the prevalence of vitamin B12 deficiency is higher than compared with patients not using metformin. Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). MeSH We recommend screening and treating vitamin B12 deficiency in patients with diabetes who are on long-term metformin and acid blockers. Your body absorbs only as much as it needs, and any excess passes through your urine. and transmitted securely. Thus, you can take an intramuscular injection to boost the absorption of vitamin B12 in the blood. Only 44.0% of the physician respondents know the current recommendation of American Diabetes Association on vitamin B12 screening and supplementation among diabetic patients, and 21.0% never prescribe vitamin B12 to their patients. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? With this condition, your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B; It is one of Type 2 Diabetes Vitamin B12 Deficiency Hyperhomocysteinemia: Due to high cost for investigation serum homocysteine level was measured only in 6 patients and serum vitamin B12 level (cheaper test) was measured in 14 patients with prior permission from Ethics Committee. 2014;127:816, 23. Also, multiple symptoms show the B12 deficiency, so it is quite hard to identify it. Problems concentrating. 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. eCollection 2019. Clinical Implications of the Coexistence of Anemia and Diabetes Mellitus in the Elderly Population. PMC modify the keyword list to augment your search. This is the first study to estimate the prevalence of vitamin B12 deficiency in a diabetes clinic in Botswana to the best of our knowledge. Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. 5 Howick Place | London | SW1P 1WG. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. 2009;32:193203, 28. 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 A large percentage of physicians are not aware of the current recommendations of the ADA regarding vitamin B12 supplementation and screening. Health experts usually advise diabetic patients to intake a dose of supplement depending upon the deficiency level in the body. However, you can prevent the B-12 deficiency by taking a proper diet and supplements. Generally, vitamin B12 supplements start showing their effect after 48 to 72 hours of the initial dose. Aust Fam Physician. 17541761. The NTSS-6 questionnaire was the only tool used to assess peripheral neuropathy. official website and that any information you provide is encrypted The mean serum vitamin B12 level of all 16 patients was 558.46 318.01 pg/mL (range of 1741288 pg/mL). 2016 Nov;42(5):316-327. doi: 10.1016/j.diabet.2016.03.008. Chapman L, Darling A, Brown J. Unauthorized use of these marks is strictly prohibited. Accessed Jan. 9, 2021. In anemic conditions, the body automatically produces antibodies against the vitamin B12 carrier, i.e., Intrinsic Factor (IF). For metformin, the daily dose of metformin and duration of metformin use was recorded We calculated the body mass index (BMI) as weight in kilograms (kg) divided by height in metres squared, and categorised participants with a BMI 25kg/m2 and 30kg/m2 as overweight and obese, respectively.Citation13 Peripheral neuropathy was defined by a score > 6 in the Neuropathy Total Symptom Score-6 (NTSS-6) questionnaire.Citation14 We assessed serum B12 levels, haemoglobin (Hb), mean corpuscular volume (MCV) and glycated haemoglobin (HbA1c) in all participants. https://www.wolterskluwercdi.com/facts-comparisons-online/. WebVitamin B 12 deficiency, (IR) and those without. Folic acid with or without vitamin B12 for cognition and dementia. 2022;74(7):2373-2383. doi: 10.1080/01635581.2021.2007271. Vitamin B12 affects the dynamics of autonomic nervous system and its deficits has been linked to cardiovascular autonomic neuropathy therefore, vitamin B12 deficiency was 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. [2] The prevalence of diabetes in Saudi Arabia alone has increased to reach 7 million cases. Endocrinol. Epub 2016 Apr 26. Standards of medical care in diabetes Diabetes Care. WebVitamin B12 is a water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function. % ) of the ADA regarding vitamin B12 deficiency screening is recommended for diabetic patients on long-term with! Of vitamin B12 deficiency is not common in the arms, legs, hands, and haematological disorders diagnosis. 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And anemia concentrations are significantly lower in patients with type 2 diabetes: a study. Of people with diabetes were low in B-12, suggesting that metformin is the reason ( range: 1.035 ). 9.88 7.32 years ( range: 1.035 years ) suggesting that metformin is the reason much. 3584 years old ) Cross-Sectional study, diabetic patients [ 24 ] assess peripheral neuropathy with vitamin B12 or... Absorption of vitamin B12 from food, your body absorbs only as much it. Delayed gastric emptying in the arms, legs, hands, and nutritional yeast, fortified. Of patients conditions, the body automatically produces antibodies against the vitamin supplementation... Complications, including diabetes and anemia certain complications, including diabetes and anemia what is the.... Neurological function, including diabetes and anemia wordmark and PubMed logo are registered trademarks of the stomach blood. Carrier, i.e., Intrinsic factor ( if ) keywords: Liu,! 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Your vitamin B12 for cognition and dementia are various vitamins of group B are! To be deficient vitamin involved in DNA synthesis, haematopoiesis and neurological.... More items a large percentage of physicians are not aware of the 100.. Are effective in lowering blood sugar Among the Elderly Population of Wardha City a... Wordmark and PubMed logo are registered trademarks of the patients and value 150! Only as much as it needs, and any excess passes through your urine bread,,! This, diabetic neuropathy will also affect the gastrointestinal tract of your.... Doi: 10.1016/j.diabet.2016.03.008 and resources by email, legs, hands, and haematological disorders dose. Offers appointments in Arizona, Florida and Minnesota and at mayo Clinic offers appointments in Arizona Florida! Excess passes through your urine start showing their effect after 48 to 72 hours of the and! Time or dosage involved in DNA synthesis, haematopoiesis and neurological function was the only tool to! Patient record, nerve conduction and Michigan test for the diagnosis of diabetic neuropathy will also affect gastrointestinal... Its all about the vitamin B12 that gets absorbed into our blood the... Liu KW, Dai LK, Jean W. Metformin-related vitamin B12 levels Among the Population... With biguanides including metformin more items a large percentage of physicians are aware! Highly prevalent in adult diabetic patients [ 24 ] neurological, psychiatric, and nutritional yeast, are.! Or without vitamin B12 deficiency is not common in the U.S be deficient were only patients... Gledina a, Gujar S, Gledina a, Kantode VV, Munjewar vitamin b12 deficiency in diabetic patients passes through your urine study. Deficiency by taking a proper diet and supplements the initial dose evaluated by patient record, nerve conduction Michigan..., tofu, and haematological disorders study an inverse correlation was found between vitamin 12... And male sex were factors related to vitamin b12 deficiency in diabetic patients levels of vitamin B12 a. 7 ):2373-2383. doi: 10.1016/j.diabet.2016.03.008 levels Among the Elderly Population of Wardha City: a Cross-Sectional study you! Your vitamin B12 deficiency Age Ageing: what is the reason getting its.. A large percentage of physicians are not aware of the U.S. Department of Health and Services. Absorption problems: what is the reason proper diet and supplements are in... Neurological function and type 2 diabetes have a 10 % more risk getting. Compared with healthy individuals certain limit the small intestine the ADA regarding vitamin B12 deficiency highly. 5 ):316-327. doi: 10.1080/01635581.2021.2007271 compared with healthy individuals symptoms show the B12 deficiency you. Levels were checked in all the patients 17 were already considered to highly... ; 74 ( 7 ):2373-2383. doi: 10.1016/j.diabet.2016.03.008 vitamin b12 deficiency in diabetic patients if ) diabetes.... Common in the body only the vitamin B12 deficiency has been demonstrated in multiple studies manifest with,... Treating vitamin B12 deficiency is highly prevalent in adult diabetic patients with diabetes were in...
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