https://doi.org/10.4081/acbr.2023.333
Prevalence and determinants of Vitamin B12 deficiency among subjects with Type 2 Diabetes in a tertiary institution in Southeast Nigeria
Submitted: 26 April 2023
Accepted: 6 June 2023
Published: 26 July 2023
Accepted: 6 June 2023
Abstract Views: 270
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Vitamin B12 (Vit B12) deficiency is very common among diabetic subjects, although with variable prevalence. The aim of this study is to determine the prevalence of Vit B12 deficiency and its associated factors among patients with Diabetes Mellitus (DM). This study is important because Vit B12 deficiency is associated with metformin, which is a bedrock in the management of diabetic subjects. Since peripheral neuropathy is a recognized complication of DM, and also occurs in Vit B12 deficiency, it would be important to ascertain the role of Vit B12 deficiency in the emergence of peripheral neuropathy. Appropriate measures like vitamin supplementation would then be instituted in diabetics who are on metformin. A cross-sectional study was conducted at Enugu State University Teaching Hospital in Enugu, Nigeria, between January to July 2019. A total of 422 patients who fit the eligibility criteria were included in the study. Data on demographics, medication use, and anthropometry were obtained from each subject, while blood was drawn to study Vit B12 levels, Haemoglobin (Hb), Mean Cell Volume (MCV), and Glycated Heamoglobin (HbA1c). Vitamin B12 deficiency was defined as serum B12 level of ≤200 pg/mL. The prevalence of vitamin B12 deficiency among Type 2 DM patients was 16.6% (n=364). Predictors of Vit B12 deficiency in Type 2 diabetic subjects included duration of metformin use of more than five years (p<0.0001). Other predictors of vitamin B12 deficiency include Body Mass Index (BMI), diabetes duration, and macrocytic anemia. This study suggests that the prevalence of Vit B12 deficiency among patients with DM in our population is substantial. This is more frequent among patients who have been on metformin for more than five years.
Guariguata L, Whiting DR, Hambleton I, et al. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract 2014;103:137-49.
DOI: https://doi.org/10.1016/j.diabres.2013.11.002
Lin X, Xu Y, Pan X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep 2020;10:14790.
DOI: https://doi.org/10.1038/s41598-020-71908-9
Nawaz A, Khattak NN, Khan MS, et al. Deficiency of vitamin B12 and its relation with neurological disorders: a critical review. JoBAZ 2020;81:10.
DOI: https://doi.org/10.1186/s41936-020-00148-0
Metz J. A High Prevalence of Biochemical Evidence of Vitamin B12 or Folate Deficiency does not translate into a Comparable Prevalence of Anemia. Food and Nutrition Bulletin 2008;29:74-85.
DOI: https://doi.org/10.1177/15648265080292S111
Lindenbaum, J, Rosenberg, IH, Wilson, PW, et al. Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr 1994;60:2–11.
DOI: https://doi.org/10.1093/ajcn/60.1.2
Rajiv S, Arpan G, Vineat S, et al. Vitamin B12 deficiency is endemic in Indian population: a perspective from North India. Indian J Endocrinol Metab 2019;23:211-4.
DOI: https://doi.org/10.4103/ijem.IJEM_122_19
Xavier JM, Costa FF, Annuchino-Bizzacchi JM, Saad ST. High prevalence of Vit B12 deficiency in a Brazilian population. Public Health Nutri 2010;13:1191-7.
DOI: https://doi.org/10.1017/S1368980009992205
Ankar A, Kumar A. Vitamin B12 Deficiency. Available from: StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK441923/
Hannibal L, Lysne V, Bjorke-Monsen AL. Biomarkers and algorithms for the diagnosis of vitamin B12 deficiency. Front Mol Biosci 2016;3:27.
DOI: https://doi.org/10.3389/fmolb.2016.00027
Ekabe CJ, Kehbila J, Abanda MH, et al. Vitamin B12 deficiency neuropathy; a rare diagnosis in young adults: a case report. BMC Res Notes 2017;10:72.
DOI: https://doi.org/10.1186/s13104-017-2393-3
Miller JW. Proton Pump Inhibitors, H2-Receptor Antagonists, Metformin, and Vitamin B-12 Deficiency: Clinical Implications. Adv Nutr 2018;9:511S-8S.
DOI: https://doi.org/10.1093/advances/nmy023
Nouri A, Kishan P, Julio M, et al. The Role of Vitamin B12 in the Management and Optimization of Treatment in Patients with Degenerative Cervical Myelopathy. Global Spinal J 2019;9:331-7.
DOI: https://doi.org/10.1177/2192568218758633
Kumar N. Neurologic aspects of cobalamin (B12) deficiency. Handb Clin Neurol 2014;120:915–26.
DOI: https://doi.org/10.1016/B978-0-7020-4087-0.00060-7
Serin HM, Arslan EA. Neurological symptoms of vitamin B12 deficiency: analysis of pediatric patients. Acta Clin Croat 2019;58:295–302.
Fisher M, Wu M, Demets D. Sample size determination in clinical research. J controlled Clinical Trials 1980;1:111–23.
DOI: https://doi.org/10.1016/0197-2456(80)90014-8
Carmel R, Green R, Rosenblatt DS, Watkins D. Update on cobalamin, folate, and homocysteine. Hematology Am Soc Hematol Educ Program 2003:62–81.
DOI: https://doi.org/10.1182/asheducation-2003.1.62
Owhin SO, Adaja TM, Fasipe OJ, et al. Prevalence of vitamin B12 deficiency among metformin-treated type 2 diabetic patients in a tertiary institution, South-South Nigeria. SAGE Open Med 2019;7:2050312119853433.
DOI: https://doi.org/10.1177/2050312119853433
Akinlade KS, Agbebaku SO, Rahamon SK , Balogun WO. VITAMIN B12 LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS ON METFORMIN Ann Ibd. Pg. Med 2015;13:79-83.
Akabwai GP, Kibirige D, Mugenyi L, et al. Vitamin B12 deficiency among adult diabetic patients in Uganda: relation to glycaemic control and haemoglobin concentration. J Diabetes Metab Disord 2016;15:26.
DOI: https://doi.org/10.1186/s40200-016-0250-x
Elsayed MA, Ibrahim WM, Magdi MA, Elbadawy A. Prevalence of B12 Deficiency among diabetic patients in Benha City, Egypt a hospital based: a cross sectional study. BMJ 2022;39:334-45.
DOI: https://doi.org/10.21608/bmfj.2021.94243.1475
Pflipsen MC, Oh RC, Saguil A, et al. The prevalence of vitamin B(12) deficiency in patients with type 2 diabetes: a cross-sectional study. J Am Board Fam Med 2009;22:528-34.
DOI: https://doi.org/10.3122/jabfm.2009.05.090044
Patel SV, Makwana AB, Gandhi AU, et al. Factors associated with vitamin B12 deficiency in adults attending tertiary care Hospital in Vadodara: a case control study. Egypt J Intern Med 2022;34:11.
DOI: https://doi.org/10.1186/s43162-022-00104-0
Loikas S, Koskinen P, Irjala K, et al. Vitamin B12 deficiency in the aged: a population-based study. Age Ageing 2007;36:177-83.
DOI: https://doi.org/10.1093/ageing/afl150
Yakubu M, Laing EF, Nsiah P, et al.Vitamin B12 deficiency in type 2 diabetic patients on metformin: a cross-sectional study from South-Western part of Ghana, Alexandria J of Med 2019;55;1:58-67.
DOI: https://doi.org/10.1080/20905068.2019.1662647
Wile DJ, Toth C. Association of metformin, elevated homocysteine, and methylmalonic acid levels and clinically worsened diabetic peripheral neuropathy. Diabetes Care 2010;33:156–61.
DOI: https://doi.org/10.2337/dc09-0606
Bauman WA, Shaw S, Jayatilleke E, et al. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23:1227-31.
DOI: https://doi.org/10.2337/diacare.23.9.1227
Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B(12) deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975-9.
de Jager J, Kooy A, Lehert P, et al. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial. BMJ 2010;340:c2181.
DOI: https://doi.org/10.1136/bmj.c2181
Ahmed MA, Muntingh G, Rheeder P. Vitamin B12 deficiency in metformin-treated type-2 diabetes patients, prevalence and association with peripheral neuropathy. BMC Pharmacol Toxicol 2016;17:44.
DOI: https://doi.org/10.1186/s40360-016-0088-3
Kim J, Ahn CW, Fang S, et al. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore) 2019;98:e17918.
DOI: https://doi.org/10.1097/MD.0000000000017918
Aroda VR, Edelstein SL, Goldberg RB, et al. Diabetes Prevention Program Research Group. Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study. J Clin Endocrinol Metab 2016;101:754-61.
DOI: https://doi.org/10.1210/jc.2015-3754
Sugawara K, Okada Y, Hirota Y, et al. Relationship between metformin use and vitamin B12 status in patients with type 2 diabetes in Japan. J Diabetes Investig 2020;11:917-22.
DOI: https://doi.org/10.1111/jdi.13200
Raizada N, Jyotsna VP, Sreenivas V, Tandon N. Serum Vitamin B12 Levels in Type 2 Diabetes Patients on Metformin Compared to those Never on Metformin: A Cross-sectional Study. Indian J Endocrinol Metab 2017;21:424-8.
DOI: https://doi.org/10.4103/ijem.IJEM_529_16
Payal L, Payel K, Walhe R. Traditionally Fermented Foods as Source of Vitamin B12 Producing LAB. Int J Life Sci 2021;9:162-8.
AL-Esawi A, Alaaraji S. Exploration of the relationship of vitamin B12 with some anthropometric measurements in Type2 diabetic patients. Eurasian Journal of Biosciences 2020;14:2893-901.
Ting RZ, Szeto CC, Chan MH, et al. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1975–9.
DOI: https://doi.org/10.1001/archinte.166.18.1975
Shahwan M, Gacem SA, Shahwan M, Najjar O. Assessment of vitamin B12 deficiency and associated risk factors among type 2 diabetic patients in Palestine. Human Nutrition and Metabolism 2020;20:200113.
DOI: https://doi.org/10.1016/j.hnm.2020.200113
Krishnan GD, Zakaria MH, Yahaya N. Prevalence of Vitamin B12 Deficiency and its Associated Factors among Patients with Type 2 Diabetes Mellitus on Metformin from a District in Malaysia. J ASEAN Fed Endocr Soc 2020;35:163-8.
DOI: https://doi.org/10.15605/jafes.035.02.03
How to Cite
Michael Chinweuba, A., Theophilus Ejiofor, U., & Uzoma Chukwunonso, O. (2023). Prevalence and determinants of Vitamin B12 deficiency among subjects with Type 2 Diabetes in a tertiary institution in Southeast Nigeria. Annals of Clinical and Biomedical Research, 4(1). https://doi.org/10.4081/acbr.2023.333
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