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An observational study of vitamin b12 levels and peripheral neuropathy profile in patients of diabetes mellitus on metformin therapy.

Abstract

METHODS

A descriptive, observational study was completed in a tertiary care hospital between November 2014 and March 2016. Fifty consecutive patients of Type 2-Diabetes Mellitus who had been on metformin therapy for at least three months were included in our study. Several Parameters were compared with vitamin B12 levels and severity of peripheral neuropathy (using Toronto Clinical Scoring System (TCSS) and Nerve Conduction Velocity). These included the duration of diabetes, duration of metformin usage, dietary history, and HbA1c levels. Definite B12 deficiency was defined as B12<150pg/ml and possible B12 deficiency as <220pg/ml.

RESULTS

In our study, we found a negative correlation between duration of metformin use and Vitamin B12 levels(r=-0.40). The mean Vitamin B12 levels seen in our study was 212.3pg/mL. There is a positive correlation between the duration of metformin therapy and peripheral neuropathy (r=0.40). The mean TCSS score was 6.8. The percentage of patients with mild neuropathy was 28%, with moderate neuropathy was 20% and severe neuropathy in 12% of the patients. The average duration of metformin use in patients without peripheral neuropathy was 5.5yrs whereas the average length of metformin use in patients with peripheral neuropathy was 10.4 yrs.

CONCLUSION

Patients on long-term metformin therapy are at a high risk for Vitamin B12 deficiency and peripheral neuropathy. Interval Screening for peripheral neuropathy is recommended for patients on metformin even if Vitamin B12 levels appear to be normal.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, Lady Hardinge Medical College, Shaheed Bhagat Singh Road, Diz Area, Connaught Place, New Delhi, 110001, India. Electronic address: kameshg9@gmail.co.

    ,

    Department of Medicine, Lady Hardinge Medical College, Shaheed Bhagat Singh Road, Diz Area, Connaught Place, New Delhi, 110001, India. Electronic address: anandjz@gmail.com.

    Department of Medicine, Lady Hardinge Medical College, Shaheed Bhagat Singh Road, Diz Area, Connaught Place, New Delhi, 110001, India. Electronic address: anurogi@yahoo.co.in.

    Source

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Biomarkers
    Blood Glucose
    Diabetes Mellitus, Type 2
    Female
    Follow-Up Studies
    Glycated Hemoglobin A
    Humans
    Hypoglycemic Agents
    Male
    Metformin
    Middle Aged
    Peripheral Nervous System Diseases
    Prognosis
    Prospective Studies
    Vitamin B 12
    Vitamin B 12 Deficiency

    Pub Type(s)

    Journal Article
    Observational Study

    Language

    eng

    PubMed ID

    28882470

    Citation

    Gupta, Kamesh, et al. "An Observational Study of Vitamin B12 Levels and Peripheral Neuropathy Profile in Patients of Diabetes Mellitus On Metformin Therapy." Diabetes & Metabolic Syndrome, vol. 12, no. 1, 2018, pp. 51-58.
    Gupta K, Jain A, Rohatgi A. An observational study of vitamin b12 levels and peripheral neuropathy profile in patients of diabetes mellitus on metformin therapy. Diabetes Metab Syndr. 2018;12(1):51-58.
    Gupta, K., Jain, A., & Rohatgi, A. (2018). An observational study of vitamin b12 levels and peripheral neuropathy profile in patients of diabetes mellitus on metformin therapy. Diabetes & Metabolic Syndrome, 12(1), pp. 51-58. doi:10.1016/j.dsx.2017.08.014.
    Gupta K, Jain A, Rohatgi A. An Observational Study of Vitamin B12 Levels and Peripheral Neuropathy Profile in Patients of Diabetes Mellitus On Metformin Therapy. Diabetes Metab Syndr. 2018;12(1):51-58. PubMed PMID: 28882470.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - An observational study of vitamin b12 levels and peripheral neuropathy profile in patients of diabetes mellitus on metformin therapy. AU - Gupta,Kamesh, AU - Jain,Anand, AU - Rohatgi,Anurag, Y1 - 2017/08/25/ PY - 2017/08/09/received PY - 2017/08/20/accepted PY - 2017/9/9/pubmed PY - 2018/9/13/medline PY - 2017/9/9/entrez KW - Diabetic neuropathy KW - Metformin KW - NCV KW - TCSS KW - Vitamin B12 SP - 51 EP - 58 JF - Diabetes & metabolic syndrome JO - Diabetes Metab Syndr VL - 12 IS - 1 N2 - METHODS: A descriptive, observational study was completed in a tertiary care hospital between November 2014 and March 2016. Fifty consecutive patients of Type 2-Diabetes Mellitus who had been on metformin therapy for at least three months were included in our study. Several Parameters were compared with vitamin B12 levels and severity of peripheral neuropathy (using Toronto Clinical Scoring System (TCSS) and Nerve Conduction Velocity). These included the duration of diabetes, duration of metformin usage, dietary history, and HbA1c levels. Definite B12 deficiency was defined as B12<150pg/ml and possible B12 deficiency as <220pg/ml. RESULTS: In our study, we found a negative correlation between duration of metformin use and Vitamin B12 levels(r=-0.40). The mean Vitamin B12 levels seen in our study was 212.3pg/mL. There is a positive correlation between the duration of metformin therapy and peripheral neuropathy (r=0.40). The mean TCSS score was 6.8. The percentage of patients with mild neuropathy was 28%, with moderate neuropathy was 20% and severe neuropathy in 12% of the patients. The average duration of metformin use in patients without peripheral neuropathy was 5.5yrs whereas the average length of metformin use in patients with peripheral neuropathy was 10.4 yrs. CONCLUSION: Patients on long-term metformin therapy are at a high risk for Vitamin B12 deficiency and peripheral neuropathy. Interval Screening for peripheral neuropathy is recommended for patients on metformin even if Vitamin B12 levels appear to be normal. SN - 1878-0334 UR - https://www.unboundmedicine.com/medline/citation/28882470/An_observational_study_of_vitamin_b12_levels_and_peripheral_neuropathy_profile_in_patients_of_diabetes_mellitus_on_metformin_therapy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1871-4021(17)30287-4 DB - PRIME DP - Unbound Medicine ER -