January 7, 2014

Another Impromptu Meeting Asked by Our Local Doctor

Early this afternoon, I received an email asking if I would attend an impromptu meeting to discuss what needed to be done as a doctor would not test for Vitamin B12 or any vitamin or mineral deficiencies. One additional comment was included asking a few of us to research what the American Diabetes Association (ADA) said about this in their guidelines.

Since I have been studying the new 2014 guidelines since I discovered them on December 31, 2013, I knew there was nothing to be found. I went to the American Association of Clinical Endocrinologist (AACE) site to see if there was anything that I hadn't read before, but again nothing about testing for deficiencies. I knew there would be articles in Medscape and other places, so I called on my search engine to help me find them.

Success! I even located one reference on the ADA site, but not part of the guidelines.
The percentage of people with type 2 diabetes taking metformin and developing vitamin B12 deficiency varies from 6 to 52 percent depending on the study. I quickly sent off the URLs to Tim since he would have his laptop at the meeting. Then I copied and printed several points to have at the ready from the ADA and included the following - “Several researchers have made recommendations to screen those with type 2 diabetes on metformin for serum B12 levels. However, no formal recommendations have been provided by the medical community or the U.S. Prevention Services Task Force.”

Ten of our members were present and talking before the doctor arrived. He was upset and we could tell this. He apologized to Allen and stated that this meeting should not have been necessary. He had thought that he had been convincing enough in his presentation to the doctor Allen had trouble with about vitamin B12 deficiency. The doctor then explained that at noon, he had received a call and was told that the ADA did not have anything in the new guidelines about testing for vitamin B12 deficiency and as such, he was not going to test. He did not feel the cost, though small was worth the small percent of people that would be deficient.

Tim took over and said that he had several good articles and that I had a handout from the ADA site for another article not part of the ADA guidelines. I handed out my print out and pointed out the information I have in red above. Allen was surprised at this, and asked why no one would take responsibility for testing. The doctor said he was and that some other doctors would be testing. He asked if Tim could put up the article from ADA and Tim said it would be shortly.

After Tim had the article up, he scrolled down to this. “Although classical B12 deficiency presents with clinical symptoms such as anemia, peripheral neuropathy, depression, and cognitive impairment, these symptoms are usually absent in those with biochemical B12 deficiency.” The doctor had to ask how many knew about this and 7 of those present put their hands up. He said it is no wonder you people do research. He said he was aware of anemia, depression and cognitive impairment, but not the other two symptoms. He added this is the reason he asked for the impromptu meeting as even he could learn.

Allen spoke up and said the individual he brought in was complaining about neuropathy and that is why he thought he could be B12 deficient. He said that was also the reason he had been taken to see the endocrinologist. He was also anemic at the time. Tim stated that we try to inform our members about this and make sure, if they are on metformin for any length of time, that they are tested.

After more discussion, Tim pulled up the article from WebMD and this generated even more discussion. The doctor commented that with these two articles, he wonders why the ADA will not take a position about testing for B12 deficiency. He said he now appreciates our group even more with this meeting and the information we were able to provide. He asked one final question about whether he should consider testing the elderly, above the age of 65 for B12 and vitamin D. Several of the group answered yes, but he noticed I had not answered so he turned to me.

I said that was a difficult question. I would answer yes for anyone with diabetes, but this would be a judgmental call on his part for people without diabetes. He said if he started at age 70, would I change my answer. I said that first he should asked the patient if he/she was taking separate vitamin B12 and D supplements. If they were, he would need to ask questions about neuropathy and he would probably need to explain what neuropathy or peripheral neuropathy was. He would also need to ask if any other doctor had tested for these.

I said if this was also part of the annual exam, then the tests could be done as part of this and then only annually if they were in the lower part of the accepted range. I said that if cognitive impairment or any of the other symptoms were suspected, then yes, do the tests.

The doctor then thanked everyone for attending and asked if there were any questions. Receiving none, he asked Tim to send an email with the URLs and a copy of the summary of the meeting to him. With that, the meeting ended.

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