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Association of B12 deficiency and clinical neuropathy with metformin use in type 2 diabetes patients.
J Postgrad Med 2013 Oct-Dec; 59(4):253-7JP

Abstract

CONTEXT

Long-term metformin use has been hypothesized to cause B12 deficiency and neuropathy in Type 2 diabetes patients. However, there is a paucity of Indian data regarding the same.

AIM

To compare the prevalence of B12 deficiency and peripheral neuropathy in patients with Type 2 diabetes mellitus treated with or without metformin.

MATERIALS AND METHODS

We recruited patients with Type 2 diabetes and divided them into metformin exposed and nonmetformin exposed groups. We measured baseline demographic variables like age, sex, vegetarian status, and HbA1c levels in both groups. We compared vitamin B12 levels and severity of peripheral neuropathy (using Toronto Clinical Scoring System (TCSS)) in both groups. Definite B12 deficiency was defined as B12 <150 pg/ml and possible B12 deficiency as <220 pg/ml. The difference in vitamin B12 levels and TCSS was calculated in both groups using independent samples t-test. Spearman's rank correlation between cumulative metformin use and B12 level was calculated. Odds ratio of vitamin B12 deficiency in metformin exposed group was also estimated.

RESULTS

Mean serum B12 levels was significantly lower in metformin exposed group (n=84) compared with nonmetformin exposed group (n=52) (410±230.7 versus 549.2±244.7, P=0.0011). Mean neuropathy score was significantly higher in metformin exposed group. (5.72±2.04 versus 4.62±2.12, P=0.0064). Odds ratio for possible B12 deficiency was 4.45 (95% CI 1.24-15.97). There was significant negative correlation between cumulative metformin dose and vitamin B12 level (r=-0.68, P<0.0001).

CONCLUSION

Metformin use is associated with vitamin B12 deficiency and clinical neuropathy in Type 2 diabetes patients.

Authors+Show Affiliations

Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

24346380

Citation

Singh, A K., et al. "Association of B12 Deficiency and Clinical Neuropathy With Metformin Use in Type 2 Diabetes Patients." Journal of Postgraduate Medicine, vol. 59, no. 4, 2013, pp. 253-7.
Singh AK, Kumar A, Karmakar D, et al. Association of B12 deficiency and clinical neuropathy with metformin use in type 2 diabetes patients. J Postgrad Med. 2013;59(4):253-7.
Singh, A. K., Kumar, A., Karmakar, D., & Jha, R. K. (2013). Association of B12 deficiency and clinical neuropathy with metformin use in type 2 diabetes patients. Journal of Postgraduate Medicine, 59(4), pp. 253-7. doi:10.4103/0022-3859.123143.
Singh AK, et al. Association of B12 Deficiency and Clinical Neuropathy With Metformin Use in Type 2 Diabetes Patients. J Postgrad Med. 2013;59(4):253-7. PubMed PMID: 24346380.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of B12 deficiency and clinical neuropathy with metformin use in type 2 diabetes patients. AU - Singh,A K, AU - Kumar,A, AU - Karmakar,D, AU - Jha,R K, PY - 2013/12/19/entrez PY - 2013/12/19/pubmed PY - 2014/11/19/medline SP - 253 EP - 7 JF - Journal of postgraduate medicine JO - J Postgrad Med VL - 59 IS - 4 N2 - CONTEXT: Long-term metformin use has been hypothesized to cause B12 deficiency and neuropathy in Type 2 diabetes patients. However, there is a paucity of Indian data regarding the same. AIM: To compare the prevalence of B12 deficiency and peripheral neuropathy in patients with Type 2 diabetes mellitus treated with or without metformin. MATERIALS AND METHODS: We recruited patients with Type 2 diabetes and divided them into metformin exposed and nonmetformin exposed groups. We measured baseline demographic variables like age, sex, vegetarian status, and HbA1c levels in both groups. We compared vitamin B12 levels and severity of peripheral neuropathy (using Toronto Clinical Scoring System (TCSS)) in both groups. Definite B12 deficiency was defined as B12 <150 pg/ml and possible B12 deficiency as <220 pg/ml. The difference in vitamin B12 levels and TCSS was calculated in both groups using independent samples t-test. Spearman's rank correlation between cumulative metformin use and B12 level was calculated. Odds ratio of vitamin B12 deficiency in metformin exposed group was also estimated. RESULTS: Mean serum B12 levels was significantly lower in metformin exposed group (n=84) compared with nonmetformin exposed group (n=52) (410±230.7 versus 549.2±244.7, P=0.0011). Mean neuropathy score was significantly higher in metformin exposed group. (5.72±2.04 versus 4.62±2.12, P=0.0064). Odds ratio for possible B12 deficiency was 4.45 (95% CI 1.24-15.97). There was significant negative correlation between cumulative metformin dose and vitamin B12 level (r=-0.68, P<0.0001). CONCLUSION: Metformin use is associated with vitamin B12 deficiency and clinical neuropathy in Type 2 diabetes patients. SN - 0972-2823 UR - https://www.unboundmedicine.com/medline/citation/24346380/Association_of_B12_deficiency_and_clinical_neuropathy_with_metformin_use_in_type_2_diabetes_patients_ L2 - http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2013;volume=59;issue=4;spage=253;epage=257;aulast=Singh DB - PRIME DP - Unbound Medicine ER -