Called me puzzled! I have never
understood why the American Diabetes Association had never called for
testing of vitamin B12 deficiency for people taking metformin for any
length of time. Even this article shows a lack of this testing and
only calls for more research. This is why I am reversing the
situation and listing what Diabetes-in-Control lists as practice
pearls first.
Practice Pearls:
- Metformin has been linked with vitamin B12 deficiency.
- A randomized placebo-controlled trial showed that metformin use is associated with an increase in neuropathy scores for patients.
- Current guidelines do not offer specific instructions on metformin and B12 deficiency, but future research is warranted.
Yes, one of the most common and
beneficial T2DM drugs may contribute to neuropathy and vitamin
deficiency – metformin.
The link between metformin and vitamin
B12 lowering is well-known and mentioned in American Diabetes
Association guidelines as a disadvantage of the drug. However, the
ADA gives no recommendations for monitoring and prevention of vitamin
B12 deficiency for patients taking metformin. Vitamin B12 deficiency
is associated with adverse effects such as anemia, fatigue, mental
status changes, and neuropathy. Given the prevalence of neuropathy
in diabetic patients, metformin-induced vitamin B12 deficiency is
clinically relevant.
The relationship between vitamin B12
deficiency and metformin was studied in a recent randomized
placebo-controlled trial. The trial lasted 52 months and included
390 type 2 diabetes patients. They were treated with 850 mg
metformin at doses up to three times a day or a placebo. Patients
with baseline vitamin B12 deficiency or patients taking vitamin B12
supplements were excluded from the trial.
Metformin is prescribed around the
world, so this relationship warrants more investigation according to
the study authors. Future studies may clarify the relationship and
will help the authors of guidelines decide whether to recommend
testing or supplementation.
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