Metformin and diabetic neuropathy: Think of B12

Reference Alvarez M, Sierra Or, Saavedra G, Moreno S. Vitamin B12 Deficiency and diabetic neuropathy in patients who take metformin: a cross -sectional study. Endoc Connect. 2019; 8 (10): 1324-1329. Objective This study assessed the prevalence of vitamin B12 deficiency in patients who take metformin, and the relationship between vitamin B12 deficiency and diabetic neuropathy. In this cross -sectional study, the researchers used a linear regression model to evaluate variables that correlated with vitamin B and the correlation between changed vitamin B12 levels and the presence of diabetic neuropathy. Participants The researchers checked the clinical records of endocrinology patients who in 2017 an endocrinology service of a ...

04. August 2022

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reference

Alvarez M, Sierra Or, Saavedra G, Moreno S. Vitamin B 12 Defect and diabetic neuropathy in patients who take metformin: a cross -sectional study. endoc connect . 2019; 8 (10): 1324-1329.

objective

This study evaluated the prevalence of vitamin B 12 deficiency in patients who take metformin, and the relationship between vitamin b 12 deficiency and diabetic neuropathy.

draft

In this cross -sectional study, the researchers used a linear regression model to evaluate variables that correlated with vitamin B 12 mirror and the correlation between the changed vitamin B 12

participant

The researchers checked the clinical records of endocrinology patients who visited an endocrinology service from a hospital in Bogota, Colombia in 2017. They identified patients who have been treated with metformin for more than 3 months and identified retrospectively patients with diagnosed diabetes mellitus or prediabetes who have been treated longer than 3 months. The study included a total of 162 patients (72 men and 90 women) and the average age was 64 years. The average daily dose of metformin was 1,536 mg and the average duration of taking metformin was 108 months.

study parameters evaluated

researchers have measured vitamin B 12 concentrations by chemiluminescent immunoassay, and they were examined for diabetic neuropathy by using one of the following procedures: clinical records of the nerve management study or the Michigan Neuropathy Screening Instrument (MNSI).

result

Overall, little vitamin B 12 mirrors were found in 7.3 % (95 % AI: 4.0 % –12 %) of the participants. In patients with diabetic neuropathy, changed (low and borderline) vitamin B 64 % (95 % - 78 %) compared to 17 % (95 % - 26 %) in patients without diabetic neuropathy (coefficient: –110.8; AI 95 %: –165,8 ,7). ). Those who earn a higher metformin dose had lower vitamin B levels 12 (coefficient: -0.061; KI 95 %: -0.09, -0.024).

important knowledge

vitamin B 12 A deficiency is widespread, especially in patients with diabetic neuropathy. In this study, a reverse correlation between diabetic neuropathy and the plasma level of vitamin B was found 12 . Higher doses of metformin and male gender were factors that were related to lower vitamin B mirrors 12 .

practice implications

vitamin B 12 deficiency as a result of metformin is well documented. This publication brings us back to an observation reported in 1969 that the pharmaceutical metformin for diabetics (mostly type 2) can reduce the absorption of vitamin B _{12 . Thus, metformin could create or reinforce the causes of diabetic neuropathy.}

This raises the question of what else could reduce B 12 status in such a marginal state that the interference of metformin led to a deficiency in 7 % of the participants.

A survey at PubMed using the mesh terms "Diabetes and Metformin" delivered 95 publications on this topic from 1971. In 1971 Tomkin pointed out that the deficiency in B 12 conversely with stopping metformin. ^{2 This observation and recent publications certainly give the reason to take potential b 12 deficiency in patients, be it because of cancer or diabetes, although the main publication that is discussed only about 7 % of diabetics who use metformin.}

This low defect prevalence implies that the remaining 93 % of the participants do not close enough to B 12 deficiency for the additional blocking of the absorption by metformin in order to make a difference. This raises the question of what else could reduce B 12 status in such a marginal state that the interference of metformin led to a deficiency in 7 % of the participants.

celiac disease, which the absorption of B 12 in the small intestine, is such a cause of a reduced absorption. It seems that at least part of the B _{12 deficiency in diabetics. In a study, researchers tested a group of type 2 diabetics on celiac disease with immunoglobulin A (IGA) tissue-samedinase antibodies, and 1.45 % were positive. ^{3 This can be an artificially low value, since an IGA deficiency is known to be manifested in celiac disease in such cases dignity.}}

In addition, many doctors, including this expert, have observed that non -identified, uncontrolled diabetics can have diabetic peripheral neuropathy. This is the symptom through which some are initially identified. This does not mean that these diabetics may not be a b 12 deficiency, but that direct neurotoxicity of hyperglycaemia is a direct neurotoxic and that B 12 deficiency can be an additional factor.

In the conclusion discussed here, the authors state in their conclusion: "The association between diabetic neuropathy and vitamin b _{12 deficiency is of great importance, since diabetic or predicative patients, in whom diabetic neuropathy was diagnosed, can have neuropathy due to vitamin B deficiency." While this appears true, the publication of the idea seems to be dedicated that B 12 deficiency is only due to metformin, which does not seem to be true.}

This expert is convinced that doctors should assess the entire intestinal absorption in all of our patients, not only from those who receive metformin. Nevertheless, this publication is a timely reminder, on B 12 status in all patients who take metformin, and especially those who have symptoms of neuropathy.

NOTE: Vitamin B 12 values were classified as low when they were below 200 pg/ml, as borderline if they were between 200 and 300 pg/ml, and as normal if they were over 300 pg/ml.

Berchtold P., Bolli P., Arbenz U., Keizer G. [Disturbance of Intestinal Absorption Following Metformin Therapy (Observations on the Mode of Action of Biguanides)] [Article in German]. diabetology . 1969; 5 (6): 405-412.
Tomkin GH, Hadden Dr, Weaver yes, Montgomery there. Vitamin B12 status of patients under Metformin long-term therapy. br med j . 1971; 2 (5763): 685-687.
Kizilgul, M., Ozcelik, O., Beysel, S., et al. Screening on celiac disease with poorly set diabetes mellitus type 2: is it worth it or not? BMC endocr disord . 2017; 17 (1): 62.