Serum Folic Acid and Vitamin B12 Levels in Diabetic Patients Under Metformin treatment Compared with Treatment with Insulin and other Glucose-Lowering Medications

Document Type : Original Article

Authors

1 Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

2 Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

3 - Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Abstract

Background and Objectives:This study was designed to compare the serum folic acid and vitamin B12 levels in type 2 diabetes patients among ptients being under treatment with metformin with those being treated with other antidiabetic drugs or insulin.
Subjects and Methods: This epidemiological analytical (case- control study) was carried out on 40 diabetic patients reffered to Golestan hospital diabetes clinic of Ahvaz in 2012-2013. Patients who were treated with metformin for more than one year were considered as case group (n=20, 14 female and 6 male, aged 53.75±9.32 years) and patients who were treated with other anti-diabetic drugs and insulin were considered as control group. A fasting blood sample was collected from both patient groups and the level of serum folic acid and vitmain B12 was measured. Correlaton between serum folic acid and vitmain B12 with age, sex, disease duration, dosage of metformin intake and BMI were statitically analysed. Data analysis was carried out using SPSS 17.
Results: No significant differences in B12 and folic acid serum levels between the two groups. Significant relationship was not shown between age and folic acid (P=0.47), vitamin B12 (P=0.76) serum levels as well as disease duration and body mass index (BMI). The mean serum folic acid and vitamin B12 in men and women of case group and control group showed no significant differences (P=0.7 and 0.07 respectively). Conclusion: In this study, there was no significant correlation between metformin consumption and serum vitamin B12 and folic acid levels. Age, disease duration, duration of metformin consumption, metformin dosage intake and BMI had no effect on serum vitamin B12 and folic acid levels.

References

 
1-Ebadi AR ,Golbidi S ,Taghadosi M ,Vakili Z, Arbab B, Sarboloki SH,  et. al. Effect of metformin in serum level vitamin B12 and folic acid in patients with type 2 diabetes mellitus. Journal of Ardebil medical sciences university 2009;8(4):403-7.
2-Jager J, Kooy A, Lehert P, Wulffele MG, Kolk J, Bets D, et.al. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B12 deficiency:randomised placebo controlled trial. BMJ 2010; 340:c2181.
3-Palomba P, Falbo A, Giallauria F, Russo T, Tolino A, Zullo F, et.al.  Effects of metformin with or without supplementation with folate on homocysteine levels and vascular endothelium of women with polycystic ovary syndrome.Diabetes Care 2010; 33(2):246-51.
4-Shtaynberg N, Singh M, Sohn P, Goldman M, Cohen N. Methylmalonic acid as an indicator of vitamin B12 deficiency in patients on metformin. J of diabetes mellitus 2.01 (2012): 72.
5-Kos E, Liszek MJ, Emanuele MA, Durazo-Arvizu R, Camacho P. Effect of metformin therapy on vitamin D and vitamin B12 levels in patients with type 2 diabetes mellitus. Endocr Pract 2012; 18(2):179-84.
6-Niagi E.Vitamin B12 deficiency in type two diabetic patients using metformin at Kenyatta National Hospital. Available from http://erepository.uonbi.ac.ke:8080/xmlui/handle/123456789/82422012
7-Pflipsen M, Oh RC, Saguil A, Seehusen DA,  Seaquist D, Topolski R. The Prevalence of Vitamin B12 Deficiency in Patients with Type 2 Diabetes: A Cross-Sectional Study. The Journal of the American Board of Family Medicine  2009; 22 (5): 528-34 .
8-Pongchaidecha M, Srikusalanukul V, Chattananon A, Tanjariyaporn S. Effect of metformin on plasma homocysteine, vitamin B12 and folic acid: a cross-sectional study in patients with type 2 diabetes mellitus. Journal of the Medical Association of Thailand 2004; 87(7):780-7.
 
9-Tomkin GH, Hadden DR, Weaver JA, Montgomery DAD.Vitamin-B12 Status of Patients on Long-term Metformin Therapy. Br Med J 1971 ; 2(5763): 685–7.
10-Tomkin GH. Malabsorption of vitamin B12 in diabetic patients treated with Phenformin: A comparision with Metformin. Br Med J 1973; 3(5882): 673–5.
11-Wullfele MG, Kooy A, Lehert P, Bets D, OgteropJC,BorgerVA, et. al. Metabolic evidence that deficiencies of vit B12, folate and vitamin B6 occur. J Intern Med 2003; 254(5): 455-63.
12-Bauman WA, Shaw S, Jayatilleke E, Spungen AM, Herbert V.Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000; 23(9):1227-31.
13-Delva M, Dianne B. Vitamin B12 replacement or not. Canadian family physician 1997; 43: 917.
14-Sahin M, Tutuncu NB, Ertugrul D, Tanaci N, Guvener ND. Effect of metformin or rosiglitazone on serum concentrations of homocysteine, folate, and vitamin B12 in patients with type 2 diabetes mellitus. J Diabetes Complications 2007;21: 118-23.
15-Hermann L, Nilsson B ,Wettre S.  Vitamin B12 status of patients treated with metformin: a cross-sectional cohort study, Department of Clinical Chemistry, Uddevalla Hospital, Sweden. British Journal of Diabetes & Vascular Disease 2004; 4 ( 6): 401-6.
16-Nervo M, Lubini A, RaimundoVF, Faulhaber GAM, Leite C, FischerLM, et. al.Vitamin B12 in metformin-treated diabetic patients: a cross-sectional study in Brazil. Rev. Assoc. Med. Bras 2011; 57(1): 46-9 .
17-Wile DJ,  Toth C. Association of metformin, elevated homocysteine and methylmalonic acid levels, and clinically worsened diabetic peripheral neuropathy . Diabetes Care 33.1 (2010): 156-161.
18-Jager JD, Kooy A,  Lehert P. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B12 deficiency: randomised placebo controlled trial .BMJ 2010; 340:c2181.
19-Ting RZ, Szeto CC, Chan MH, Ma KK, Chow KM. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006; 166(18):1975-9.
20-Sato Y, Ouchi K, Funase Y, Yamauchi K, Aizawa T.Relationship between metformin use, vitamin B12 deficiency, hyperhomocysteeinemia and vascular complications in patients with type 2 diabetes.Endocrine Journal 60.12 (2013): 1275-1280.
21-Liu KW, Dai DLK, Ho W, Lau E, Woo J.Metformin-associated vitamin B12 deficiency in the elderly. Asian J Gerontol Geriatr 2011;6:82-7.
 
 
 
 
 
 
 
 
 
Jundishapur Scientific Medical Journal
Volume 14, Issue 3 - Serial Number 96
May and June 2015
Pages 344-351

Files

History

  • Receive Date: 20 June 2017
  • Accept Date: 20 June 2017

Share

How to cite

Statistics