Singh A K, Kumar A, Karmakar D, Jha R K
Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
J Postgrad Med. 2013 Oct-Dec;59(4):253-7. doi: 10.4103/0022-3859.123143.
Long-term metformin use has been hypothesized to cause B12 deficiency and neuropathy in Type 2 diabetes patients. However, there is a paucity of Indian data regarding the same.
To compare the prevalence of B12 deficiency and peripheral neuropathy in patients with Type 2 diabetes mellitus treated with or without metformin.
We recruited patients with Type 2 diabetes and divided them into metformin exposed and nonmetformin exposed groups. We measured baseline demographic variables like age, sex, vegetarian status, and HbA1c levels in both groups. We compared vitamin B12 levels and severity of peripheral neuropathy (using Toronto Clinical Scoring System (TCSS)) in both groups. Definite B12 deficiency was defined as B12 <150 pg/ml and possible B12 deficiency as <220 pg/ml. The difference in vitamin B12 levels and TCSS was calculated in both groups using independent samples t-test. Spearman's rank correlation between cumulative metformin use and B12 level was calculated. Odds ratio of vitamin B12 deficiency in metformin exposed group was also estimated.
Mean serum B12 levels was significantly lower in metformin exposed group (n=84) compared with nonmetformin exposed group (n=52) (410±230.7 versus 549.2±244.7, P=0.0011). Mean neuropathy score was significantly higher in metformin exposed group. (5.72±2.04 versus 4.62±2.12, P=0.0064). Odds ratio for possible B12 deficiency was 4.45 (95% CI 1.24-15.97). There was significant negative correlation between cumulative metformin dose and vitamin B12 level (r=-0.68, P<0.0001).
Metformin use is associated with vitamin B12 deficiency and clinical neuropathy in Type 2 diabetes patients.
长期使用二甲双胍被认为会导致2型糖尿病患者出现维生素B12缺乏和神经病变。然而，印度在这方面的数据很少。
比较接受或未接受二甲双胍治疗的2型糖尿病患者中维生素B12缺乏和周围神经病变的患病率。
我们招募了2型糖尿病患者，并将他们分为二甲双胍暴露组和非二甲双胍暴露组。我们测量了两组患者的基线人口统计学变量，如年龄、性别、素食状况和糖化血红蛋白水平。我们比较了两组患者的维生素B12水平和周围神经病变的严重程度（使用多伦多临床评分系统（TCSS））。明确的维生素B12缺乏定义为维生素B12<150 pg/ml，可能的维生素B12缺乏定义为<220 pg/ml。使用独立样本t检验计算两组患者维生素B12水平和TCSS的差异。计算累积二甲双胍使用量与维生素B12水平之间的Spearman等级相关性。还估计了二甲双胍暴露组维生素B12缺乏的比值比。
与非二甲双胍暴露组（n=52）相比，二甲双胍暴露组（n=84）的平均血清维生素B12水平显著降低（410±230.7 vs 549.2±244.7，P=0.0011）。二甲双胍暴露组的平均神经病变评分显著更高（5.72±2.04 vs 4.。62±2.12，P=0.0064）。可能的维生素B12缺乏的比值比为4.45（95%CI 1.24-15.97）。累积二甲双胍剂量与维生素B12水平之间存在显著负相关（r=-0.68，P<0.0001）。
在2型糖尿病患者中，使用二甲双胍与维生素B12缺乏和临床神经病变有关。
