Association of vitamin B12 deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, Pakistan
Objective To assess the prevalence of vitamin B12 deficiency in people with type 2 diabetes mellitus (T2DM) on metformin and without metformin.Methodology Between May 2018 and January 2019, this prospective multicenter observational study recruited participants from seven centers in four provinces o...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2020-04-01
|
| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/8/1/e001151.full |
| _version_ | 1819067932359000064 |
|---|---|
| author | Asher Fawwad Nazish Waris Bilal Tahir Sobia Sabir Ali Qazi Masroor Salma Tanveer Jamal Zafar Zahid Miyan Khalid Usman Khursheed Ahmed Riaz A Malik |
| author_facet | Asher Fawwad Nazish Waris Bilal Tahir Sobia Sabir Ali Qazi Masroor Salma Tanveer Jamal Zafar Zahid Miyan Khalid Usman Khursheed Ahmed Riaz A Malik |
| author_sort | Asher Fawwad |
| collection | DOAJ |
| description | Objective To assess the prevalence of vitamin B12 deficiency in people with type 2 diabetes mellitus (T2DM) on metformin and without metformin.Methodology Between May 2018 and January 2019, this prospective multicenter observational study recruited participants from seven centers in four provinces of Pakistan (Sindh, Punjab, Baluchistan and Khyber Pakhtunkhwa). Participants with T2DM treated with metformin for >2 years and those not on metformin underwent assessment of hemoglobin, vitamin B12, homocysteine and diabetic neuropathy (vibration perception threshold (VPT) >15V) and painful diabetic neuropathy (Douleur Neuropathique 4 (DN4) ≥4) and Diabetic Neuropathy Symptom (DNS) score ≥1.Results Of 932 subjects, 645 (69.2%) were treated with metformin, while 287 (30.8%) were not on metformin. Overall, B12 deficiency (<200 pg/mL) was significantly higher in metformin users of 25 (3.9%), compared with non-metformin users of 6 (2.1%), while B12 insufficiency (200–300 pg/mL) was significantly lower in metformin users of 117 (18.4%) compared with non-metformin users of 80 (27.9%). Subjects with B12 deficiency and insufficiency with hyperhomocysteinemia (≥15) were found in 19 (76%) µmol/L and 69 (60.5%) µmol/L in metformin users compared with 6 (100%) µmol/L and 57 (73.1%) μmol/L in non-metformin users, respectively. VPT>25 and DN4 score ≥4 were significantly higher in B12-deficient metformin users compared with non-metformin users. Similarly, DNS score ≥1 was non-significantly higher in B12-deficient metformin users compared with non-metformin users.Conclusion This study shows that vitamin B12 insufficiency was frequently found in our population and may progress into B12 deficiency. It is also associated with neuropathy in subjects on metformin. Further interventional studies to assess the benefit of B12 treatment on painful neuropathy in patients on metformin may be warranted. B12 levels may be checked in people with T2DM using metformin for >2 years. |
| first_indexed | 2024-12-21T16:26:06Z |
| format | Article |
| id | doaj.art-7380ed15eaae4dc689dfac6a17028fd7 |
| institution | Directory Open Access Journal |
| issn | 2052-4897 |
| language | English |
| last_indexed | 2024-12-21T16:26:06Z |
| publishDate | 2020-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj.art-7380ed15eaae4dc689dfac6a17028fd72022-12-21T18:57:27ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972020-04-018110.1136/bmjdrc-2019-001151Association of vitamin B12 deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, PakistanAsher Fawwad0Nazish WarisBilal TahirSobia Sabir AliQazi MasroorSalma TanveerJamal ZafarZahid MiyanKhalid UsmanKhursheed AhmedRiaz A Malik2 Department of Research, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Sindh, Pakistan Objective To assess the prevalence of vitamin B12 deficiency in people with type 2 diabetes mellitus (T2DM) on metformin and without metformin.Methodology Between May 2018 and January 2019, this prospective multicenter observational study recruited participants from seven centers in four provinces of Pakistan (Sindh, Punjab, Baluchistan and Khyber Pakhtunkhwa). Participants with T2DM treated with metformin for >2 years and those not on metformin underwent assessment of hemoglobin, vitamin B12, homocysteine and diabetic neuropathy (vibration perception threshold (VPT) >15V) and painful diabetic neuropathy (Douleur Neuropathique 4 (DN4) ≥4) and Diabetic Neuropathy Symptom (DNS) score ≥1.Results Of 932 subjects, 645 (69.2%) were treated with metformin, while 287 (30.8%) were not on metformin. Overall, B12 deficiency (<200 pg/mL) was significantly higher in metformin users of 25 (3.9%), compared with non-metformin users of 6 (2.1%), while B12 insufficiency (200–300 pg/mL) was significantly lower in metformin users of 117 (18.4%) compared with non-metformin users of 80 (27.9%). Subjects with B12 deficiency and insufficiency with hyperhomocysteinemia (≥15) were found in 19 (76%) µmol/L and 69 (60.5%) µmol/L in metformin users compared with 6 (100%) µmol/L and 57 (73.1%) μmol/L in non-metformin users, respectively. VPT>25 and DN4 score ≥4 were significantly higher in B12-deficient metformin users compared with non-metformin users. Similarly, DNS score ≥1 was non-significantly higher in B12-deficient metformin users compared with non-metformin users.Conclusion This study shows that vitamin B12 insufficiency was frequently found in our population and may progress into B12 deficiency. It is also associated with neuropathy in subjects on metformin. Further interventional studies to assess the benefit of B12 treatment on painful neuropathy in patients on metformin may be warranted. B12 levels may be checked in people with T2DM using metformin for >2 years.https://drc.bmj.com/content/8/1/e001151.full |
| spellingShingle | Asher Fawwad Nazish Waris Bilal Tahir Sobia Sabir Ali Qazi Masroor Salma Tanveer Jamal Zafar Zahid Miyan Khalid Usman Khursheed Ahmed Riaz A Malik Association of vitamin B12 deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, Pakistan BMJ Open Diabetes Research & Care |
| title | Association of vitamin B12 deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, Pakistan |
| title_full | Association of vitamin B12 deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, Pakistan |
| title_fullStr | Association of vitamin B12 deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, Pakistan |
| title_full_unstemmed | Association of vitamin B12 deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, Pakistan |
| title_short | Association of vitamin B12 deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, Pakistan |
| title_sort | association of vitamin b12 deficiency in people with type 2 diabetes on metformin and without metformin a multicenter study karachi pakistan |
| url | https://drc.bmj.com/content/8/1/e001151.full |
| work_keys_str_mv | AT asherfawwad associationofvitaminb12deficiencyinpeoplewithtype2diabetesonmetforminandwithoutmetforminamulticenterstudykarachipakistan AT nazishwaris associationofvitaminb12deficiencyinpeoplewithtype2diabetesonmetforminandwithoutmetforminamulticenterstudykarachipakistan AT bilaltahir associationofvitaminb12deficiencyinpeoplewithtype2diabetesonmetforminandwithoutmetforminamulticenterstudykarachipakistan AT sobiasabirali associationofvitaminb12deficiencyinpeoplewithtype2diabetesonmetforminandwithoutmetforminamulticenterstudykarachipakistan AT qazimasroor associationofvitaminb12deficiencyinpeoplewithtype2diabetesonmetforminandwithoutmetforminamulticenterstudykarachipakistan AT salmatanveer associationofvitaminb12deficiencyinpeoplewithtype2diabetesonmetforminandwithoutmetforminamulticenterstudykarachipakistan AT jamalzafar associationofvitaminb12deficiencyinpeoplewithtype2diabetesonmetforminandwithoutmetforminamulticenterstudykarachipakistan AT zahidmiyan associationofvitaminb12deficiencyinpeoplewithtype2diabetesonmetforminandwithoutmetforminamulticenterstudykarachipakistan AT khalidusman associationofvitaminb12deficiencyinpeoplewithtype2diabetesonmetforminandwithoutmetforminamulticenterstudykarachipakistan AT khursheedahmed associationofvitaminb12deficiencyinpeoplewithtype2diabetesonmetforminandwithoutmetforminamulticenterstudykarachipakistan AT riazamalik associationofvitaminb12deficiencyinpeoplewithtype2diabetesonmetforminandwithoutmetforminamulticenterstudykarachipakistan |