Adaikalakoteswari Antonysunil, Jayashri Ramamurthy, Sukumar Nithya, Venkataraman Hema, Pradeepa Rajendra, Gokulakrishnan Kuppan, Anjana Ranjit Mohan, McTernan Philip G, Tripathi Gyanendra, Patel Vinod, Kumar Sudhesh, Mohan Viswanathan, Saravanan Ponnusamy
Cardiovasc Diabetol. 2014 Sep 26;13:129. doi: 10.1186/s12933-014-0129-4.
Metformin, a standard therapy in type 2 diabetes, reduces vitamin B12 levels. Studies linking low vitamin B12 levels and cardiovascular disease are equivocal and suggest improving B12 levels may help in primary prevention. The role of vitamin B12 deficiency on cardiovascular risk factors, especially in type 2 diabetes has not been explored. The aim of this study is to investigate whether vitamin B12 deficiency in type 2 diabetes patients is associated with cardiovascular risk factors in two different ethnic groups in UK and India.
Type 2 diabetes patients from two secondary care diabetic centres (Europeans - UK and Indians - India) were studied. Serum vitamin B12, folate and biochemical parameters were measured.
The prevalence rates of vitamin B12 deficiency (<191 ng/L) were 27% and 12% in Europeans and Indians, respectively and higher in metformin treated type 2 diabetes patients. In linear regression analysis, after adjusting for all likely confounding factors, vitamin B12 independently associated with triglycerides in both the populations and cholesterol/HDL ratio in Indians. Logistic regression showed type 2 diabetes patients with vitamin B12 deficiency were at significantly higher odds of having coexisting coronary artery disease (CAD) in Europeans with similar but non-significant trend in Indians, after adjusting for all likely confounding factors.
The prevalence of vitamin B12 deficiency is common in type 2 diabetes patients and is associated with adverse lipid parameters. Type 2 diabetes management guidelines should include the recommendation for regular testing for B12 levels, especially for those on metformin.
二甲双胍是2型糖尿病的标准治疗药物，可降低维生素B12水平。关于低维生素B12水平与心血管疾病之间联系的研究结果并不明确，提示提高B12水平可能有助于一级预防。维生素B12缺乏对心血管危险因素的影响，尤其是在2型糖尿病患者中的影响尚未得到探讨。本研究旨在调查英国和印度两个不同种族的2型糖尿病患者维生素B12缺乏是否与心血管危险因素相关。
对来自两个二级护理糖尿病中心（欧洲人——英国，印度人——印度）的2型糖尿病患者进行研究。检测血清维生素B12、叶酸和生化指标。
欧洲人和印度人维生素B12缺乏（<191 ng/L）的患病率分别为27%和12%，在接受二甲双胍治疗的2型糖尿病患者中更高。线性回归分析显示，在调整所有可能的混杂因素后，维生素B12在两个人群中均与甘油三酯独立相关，在印度人群中与胆固醇/高密度脂蛋白比值独立相关。逻辑回归显示，在调整所有可能的混杂因素后，维生素B12缺乏的2型糖尿病患者在欧洲人中患并存冠状动脉疾病（CAD）的几率显著更高，在印度人中趋势相似但不显著。
维生素B12缺乏在2型糖尿病患者中很常见，且与不良血脂参数相关。2型糖尿病管理指南应包括定期检测B12水平的建议，尤其是对服用二甲双胍的患者。
