Effect of Metformin usage on Vitamin B12 deficiency in patients with Type 2 Diabetes Mellitus


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DOI:

https://doi.org/10.26900/hsq.2580

Keywords:

Vitamin B12 deficiency, metformin, type 2 diabetes mellitus

Abstract

Metformin is the most commonly used drug in antihyperglycemic treatment in patients with type 2 diabetes mellitus (T2 DM). In recent years, there have been many studies reporting B12 deficiency in diabetic individuals using metformin drug. This study evaluates B12 deficiency in individuals with T2 DM diagnosis using metformin in our hospital. This study is a cross-sectional and descriptive research. In this study, the data of 786 patients who applied to the Mugla Education and Research Hospital Internal Medicine outpatient clinic with T2DM diagnosis and used metformin between January 01, 2018 and March 01, 2019 were evaluated. Demographic data, vitamin B12, HbA1c levels of the patients were obtained retrospectively from the hospital information system records. Patients with missing data were excluded from the study.347 (44.1%) male and 439 (55.9%) female patients were included in the study. Metformin dose of 248 (31.6%) of the patients was 1000 mg or less, 123 (15.6%) was 1700 mg, 414 (52.8%) was 2000 mg or more. According to the distribution of medication use, 161 (20.5%) patients were receiving metformin only, 322 (41%) patients were receiving metformin + other oral antidiabetic agents (OAD), and 303 (38.5%) patients were receiving metformin + insulin treatment. Vitamin B12 deficiency (57.8%) was higher in patients aged 60 years old and was over who used metformin (p<0.001). 347 (44.1%) of the patients included in the study received vitamin B12 replacement. We detected serious B12 deficiency in patients with T2DM who used metformin, especially in patients aged over 60 years old. Therefore, we emphasize the importance to monitor vitamin B12 levels in patients who are started on metformin and to perform B12 replacement in patients who are found to be deficient.

 

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References

Van Dieren S, Beulens JW, van der Schouw YT,Grobbee DE, Neal B. The global burden of diabetes and its complications: an emerging pandemic. Eur JCardiovasc Prev Rehabil 2010;17(1):3-8. doi: 10.1097/01.hjr.0000368191.86614.5a.

Magliano DJ, Boyko EJ; International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels: International Diabetes Federation; 2021. Publication No.: book_idfatlas10eISBN-13: 978-2-930229-98-0.

Ahmed MA. Metformin and Vitamin B12 Deficiency: Where Do We Stand? J Pharm Pharm Sci. 2016;19(3):382-398. doi: 10.18433/J3PK7P.

Valencia WM, Botros D, Vera-Nunez M, Dang S. Diabetes Treatment in the Elderly: Incorporating Geriatrics, Technology, and Functional Medicine. Curr Diab Rep. 2018;18(10):95. doi: 10.1007/s11892-018-1052-y.

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]. Diabetologia. 1969;5:405–412. doi: 10.1007/BF00427979.

Tomkin GH, Hadden DR, Weaver JA, Montgomery DA. Vitamin-B12 status of patients on long-term metformin therapy. Br Med J. 1971;2:685–687. doi: 10.1136/bmj.2.5763.685.

Turkish Endocrine and Metabolism Society Diabetes Mellitus and Its Complications Diagnosis, Treatment and Follow-up Guide 2024. 16th edition ISBN 978-625-99759-2-4.

Hurley-Kim K, Vu CH, Dao NM, Tran LC, McBane S, Lee J, et al. Effect of metformin use on vitamin B12 deficiency over time (EMBER): a real-world evidence database study. Endocr Pract 2023;29:862-7. doi: 10.1016/j.eprac.2023.06.013.

Green R, Allen LH, Bjørke-Monsen AL, Brito A, Guéant JL, Miller JW, Molloy AM, Nexo E, Stabler S, Toh BH, Ueland PM, Yajnik C. Vitamin B12 deficiency. Nature Revıews | Dısease Prımers 2017;29:3:17040 doi:10.1038/nrdp.2017.40.

Martin D, Thaker J, Shreve M, Lamerato L, Budzynska K. Assessment of vitamin B12 deficiency and B12 screening trends for patients on metformin: a retrospective cohort case review. BMJ Nutr Prev Health 2021;4:30-5. doi: 10.1136/bmjnph-2020-000193.

Evans JM, Ogston SA, Emslie-Smith A, Morris AD. Risk of mortality and adverse cardiovascular outcomes in type 2 diabetes: a comparison of patients treated with sulfonylureas and metformin. Diabetologia 2006 ;49(5):930-936. doi: 10.1007/s00125-006-0176-9.

de Jager J, Kooy A, Lehert P, Wulffele MG, van der Kolk J, Bets D, Verburg J, Donker AJ, Stehouwer CD. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial. BMJ 2010;20;340:c2181 doi: 10.1136/bmj.c2181.

Raizada N, Jyotsna VP, Sreenivas V, Tandon N. Serum vitamin B12 levels in type 2 diabetes patients on metformin compared to those never on metformin: A cross-sectional study. Indian J Endocr Metab 2017;21:424-8. doi: 10.4103/ijem.IJEM_529_16.

Kancherla V, Elliott JL Jr, Patel BB, Holland NW, Johnson TM 2nd, Khakhariab A, Phillips LS, Oakley GP Jr, Vaughan CP. Long-term Metformin Therapy and Monitoring for Vitamin B12 Deficiency Among Older Veterans J Am Geriatr Soc. 2017;65(5):1061–1066. doi:10.1111/jgs.14761.

Ting RZ, Szeto CC, Chan MH, Ma KK, Chow KM. (2006) Risk factors of vitamin B(12) deficiency in patients receiving metformin. Arch Intern Med.2006;166(18):1975–9 doi: 10.1001/archinte.166.18.1975.

Reinstatler L, Ping Qi Y, Williamson R. S, Garn J. V, Oakley Jr G. P. Association of biochemical B₁₂ deficiency with metformin therapy and vitamin B₁₂ supplements: the National Health and Nutrition Examination Survey, 1999-2006. Diabetes Care. 2012;35(2):327-33. doi: 10.2337/dc11-1582.

Hunt A, Harrington D, Robinson S. Vitamin B12 deficiency. BMJ. 2014;349:g5226. doi: 10.1136/bmj.g5226.

Miller J W, Smith A, Troen A M, Mason J B, Jacques P F, Selhub J. Excess Folic Acid and Vitamin B12 Deficiency: Clinical Implications? Food Nutr Bull. 2024;45(1):67-72. doi: 10.1177/03795721241229503.

CW Wong. Vitamin B12 deficiency in the elderly: is it worth screening? Hong Kong Med J. 2015;21(2):155-64. doi: 10.12809/hkmj144383.

Miller JW. Proton pump inhibitors, H2-receptor antagonists, metformin, and vitamin B-12 deficiency: clinical implications. Adv Nutr. 2018;9(4):511–518. doi: 10.1093/advances/nmy023.

ClinCalc. “Number of metformin prescriptions in the U.S. from 2004 to 2021 (in millions).” Chart. January 1, 2024. Statista. Accessed January 9, 2024. https://www.statista.com/statistics/780332/metformin-hydrochloride-prescriptions-number-in-the-us/

Pierce SA, Chung AH, Black KK. Evaluation of Vitamin B12 Monitoring in a Veteran Population on Long-Term, High-Dose Metformin Therapy. Ann Pharmacother. 2012; 46:1470–1476. doi: 10.1345/aph.1R223.

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Published

2025-01-25

How to Cite

Kırlı, İsmail, Yılmaz, V. C., Şahin, C., Salman, C. D., Yeniçeri, E. N., & Tunca, H. (2025). Effect of Metformin usage on Vitamin B12 deficiency in patients with Type 2 Diabetes Mellitus. HEALTH SCIENCES QUARTERLY, 5(1), 43–50. https://doi.org/10.26900/hsq.2580

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