Association of vitamin B12 deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, Pakistan

ObjectiveTo assess the prevalence of vitamin B12 deficiency in people with type 2 diabetes mellitus (T2DM) on metformin and without metformin.MethodologyBetween May 2018 and January 2019, this prospective multicenter observational study recruited participants from seven centers in four provinces of...

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Published in:BMJ open diabetes research & care 2020-05, Vol.8 (1)
Main Authors: Miyan, Zahid, Waris, Nazish
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Language:English
Subjects:
Age
Anemia
Antidiabetics
Binding sites
Blood pressure
Body mass index
Clinical medicine
Diabetes
Diabetic neuropathy
Epidemiology/Health Services Research
Gastrointestinal surgery
Glucose monitoring
Homocysteine
Immunoassay
Peripheral neuropathy
Sample size
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description ObjectiveTo assess the prevalence of vitamin B12 deficiency in people with type 2 diabetes mellitus (T2DM) on metformin and without metformin.MethodologyBetween 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.ResultsOf 932 subjects, 645 (69.2%) were treated with metformin, while 287 (30.8%) were not on metformin. Overall, B12 deficiency (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.ConclusionThis 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.
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Participants with T2DM treated with metformin for &gt;2 years and those not on metformin underwent assessment of hemoglobin, vitamin B12, homocysteine and diabetic neuropathy (vibration perception threshold (VPT) &gt;15V) and painful diabetic neuropathy (Douleur Neuropathique 4 (DN4) ≥4) and Diabetic Neuropathy Symptom (DNS) score ≥1.ResultsOf 932 subjects, 645 (69.2%) were treated with metformin, while 287 (30.8%) were not on metformin. Overall, B12 deficiency (&lt;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&gt;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.ConclusionThis 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 &gt;2 years.</description><identifier>EISSN: 2052-4897</identifier><identifier>DOI: 10.1136/bmjdrc-2019-001151</identifier><identifier>PMID: 32448786</identifier><language>eng</language><publisher>London: BMJ Publishing Group LTD</publisher><subject>Age ; Anemia ; Antidiabetics ; Binding sites ; Blood pressure ; Body mass index ; Clinical medicine ; Diabetes ; Diabetic neuropathy ; Epidemiology/Health Services Research ; Gastrointestinal surgery ; Glucose monitoring ; Homocysteine ; Immunoassay ; Peripheral neuropathy ; Sample size</subject><ispartof>BMJ open diabetes research &amp; care, 2020-05, Vol.8 (1)</ispartof><rights>Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2020 Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-b2206-45ea1caf335ea98ce0f7368af7c95b6e17e390e9d6eaad5fff5a3812eff417ff3</cites><orcidid>0000-0002-1592-0980</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2433228588/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2433228588?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27549,27550,27924,27925,37012,37013,44590,53791,53793,75126,77601,77632</link.rule.ids></links><search><creatorcontrib>Miyan, Zahid</creatorcontrib><creatorcontrib>Waris, Nazish</creatorcontrib><title>Association of vitamin B12 deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, Pakistan</title><title>BMJ open diabetes research &amp; care</title><description>ObjectiveTo assess the prevalence of vitamin B12 deficiency in people with type 2 diabetes mellitus (T2DM) on metformin and without metformin.MethodologyBetween 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 &gt;2 years and those not on metformin underwent assessment of hemoglobin, vitamin B12, homocysteine and diabetic neuropathy (vibration perception threshold (VPT) &gt;15V) and painful diabetic neuropathy (Douleur Neuropathique 4 (DN4) ≥4) and Diabetic Neuropathy Symptom (DNS) score ≥1.ResultsOf 932 subjects, 645 (69.2%) were treated with metformin, while 287 (30.8%) were not on metformin. Overall, B12 deficiency (&lt;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&gt;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.ConclusionThis 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 &gt;2 years.</description><subject>Age</subject><subject>Anemia</subject><subject>Antidiabetics</subject><subject>Binding sites</subject><subject>Blood pressure</subject><subject>Body mass index</subject><subject>Clinical medicine</subject><subject>Diabetes</subject><subject>Diabetic neuropathy</subject><subject>Epidemiology/Health Services Research</subject><subject>Gastrointestinal surgery</subject><subject>Glucose monitoring</subject><subject>Homocysteine</subject><subject>Immunoassay</subject><subject>Peripheral neuropathy</subject><subject>Sample size</subject><issn>2052-4897</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNpdks9u1DAQxiMkRKvSF-BkiQuHBvwnsR0OSKWiUFEJDnC2Zu1x10sSL7bTap-ir4y3W4HKydY3v_lmbH1N84rRt4wJ-W41bVyyLadsaCllrGfPmmNOe952elBHzWnOG1oLQjKh-xfNkeBdp5WWx839ec7RBighziR6chsKTGEmHxknDn2wAWe7I1XZYtyOSO5CWZOy2yKpQIAVFsyk9k5YfEz7VpjdAxWX8k99T4BMy1iCxblgIrksbndGvkICuw5n5Dv8CrnA_LJ57mHMePp4njQ_Lz_9uPjSXn_7fHVxft2uOKey7XoEZsELUS-Dtki9ElKDV3boVxKZQjFQHJxEANd773sQmnH0vmPKe3HSXB18XYSN2aYwQdqZCME8CDHdGEh12xGNEpqiY3UQYOes1IPzYCUwRbn2TlWvDwev7bKa0O1fmGB8Yvq0Moe1uYm3RvGeD1JWgzePBin-XjAXM4VscRxhxrhkwzsqe6W0EBV9_R-6iUua61dVSgjOda91pdoDVZPxdw9GzT4t5pAWs0-LOaRF_AGMA7dH</recordid><startdate>20200524</startdate><enddate>20200524</enddate><creator>Miyan, Zahid</creator><creator>Waris, Nazish</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-1592-0980</orcidid></search><sort><creationdate>20200524</creationdate><title>Association of vitamin B12 deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, Pakistan</title><author>Miyan, Zahid ; Waris, Nazish</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b2206-45ea1caf335ea98ce0f7368af7c95b6e17e390e9d6eaad5fff5a3812eff417ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Age</topic><topic>Anemia</topic><topic>Antidiabetics</topic><topic>Binding sites</topic><topic>Blood pressure</topic><topic>Body mass index</topic><topic>Clinical medicine</topic><topic>Diabetes</topic><topic>Diabetic neuropathy</topic><topic>Epidemiology/Health Services Research</topic><topic>Gastrointestinal surgery</topic><topic>Glucose monitoring</topic><topic>Homocysteine</topic><topic>Immunoassay</topic><topic>Peripheral neuropathy</topic><topic>Sample size</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Miyan, Zahid</creatorcontrib><creatorcontrib>Waris, Nazish</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing &amp; 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Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>BMJ open diabetes research &amp; care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Miyan, Zahid</au><au>Waris, Nazish</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of vitamin B12 deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, Pakistan</atitle><jtitle>BMJ open diabetes research &amp; care</jtitle><date>2020-05-24</date><risdate>2020</risdate><volume>8</volume><issue>1</issue><eissn>2052-4897</eissn><abstract>ObjectiveTo assess the prevalence of vitamin B12 deficiency in people with type 2 diabetes mellitus (T2DM) on metformin and without metformin.MethodologyBetween 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 &gt;2 years and those not on metformin underwent assessment of hemoglobin, vitamin B12, homocysteine and diabetic neuropathy (vibration perception threshold (VPT) &gt;15V) and painful diabetic neuropathy (Douleur Neuropathique 4 (DN4) ≥4) and Diabetic Neuropathy Symptom (DNS) score ≥1.ResultsOf 932 subjects, 645 (69.2%) were treated with metformin, while 287 (30.8%) were not on metformin. Overall, B12 deficiency (&lt;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&gt;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.ConclusionThis 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 &gt;2 years.</abstract><cop>London</cop><pub>BMJ Publishing Group LTD</pub><pmid>32448786</pmid><doi>10.1136/bmjdrc-2019-001151</doi><orcidid>https://orcid.org/0000-0002-1592-0980</orcidid><oa>free_for_read</oa></addata></record>
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subjects Age
Anemia
Antidiabetics
Binding sites
Blood pressure
Body mass index
Clinical medicine
Diabetes
Diabetic neuropathy
Epidemiology/Health Services Research
Gastrointestinal surgery
Glucose monitoring
Homocysteine
Immunoassay
Peripheral neuropathy
Sample size
title Association of vitamin B12 deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, Pakistan
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