CORRELATION OF VITAMIN B12 DEFICIENCY WITH METFORMIN THERAPY IN INDIAN TYPE 2 DIABETES MELLITUS PATIENTS

Abstract

Introduction: Diabetes is non-communicable disease prevalent all over the world. Metformin is most commonly prescribed and first line anti-hyperglycaemic medication of type 2 diabetes mellitus patients. Vitamin B12- Intrinsic factor complex uptake by ileal cell surface receptors is a known to be a process dependent on calcium availability. Metformin affects calcium dependant membrane action. Hence intestinal absorption of Vitamin B12 is often decreased during chronic metformin therapy.

Aims & Objectives: This study is done to assess the prevalence, severity and clinical implication of vitamin B12 deficiency in type 2 diabetes mellitus patients taking chronic metformin therapy.

Methods: The study included total 50 type 2 diabetes patients as per inclusion and exclusion criteria. Detailed history, physical examination and laboratory evaluation CBC, peripheral blood smear, renal function test, FBS,PPBS, HbA1c, serum vitamin B12 assay, urine routine & microscopy of all 50 patients. Analysis was done with help of SPSS software and using Microsoft Excel 2012.

Results: In our study, dosage of the metformin was highest among deficient group followed by borderline and normal. The mean duration of therapy with metformin is high in the deficient group. Hence the duration of therapy with metformin and the dose determines the development of vitamin deficiency. With duration of metformin and duration of diabetes showed non-significant P value which may be due to the small sample size. As it is a cross sectional study, the population is very low and it is difficult to study the P value in this population. But the mean value shows good correlation with duration and dosage of metformin therapy and duration of diabetes with B12 deficiency.

Conclusion: Chronic metformin therapy is associated with B12 deficiency by causing asymptomatic vitamin B12 deficiency. Vitamin B12 level in the patients who were on chronic metformin therapy is useful to predict B12 deficiency as they are prone for B12 deficiency. The duration and dose of metformin therapy has affected the vitamin B12 status of type 2 diabetes mellitus patients.