Fogelman Yacov, Kitai Eliezer, Blumberg Gari, Golan-Cohen Avivit, Rapoport Micha, Carmeli Eli
Department of Family Practice, Leumit Health Maintenance Organization (HMO), Tel Aviv, Israel.
The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
Aging Clin Exp Res. 2017 Apr;29(2):135-139. doi: 10.1007/s40520-016-0546-1. Epub 2016 Feb 22.
Low serum B12 level is a common occurrence in patients with type 2 diabetes (T2DM) treated with metformin. There is lack of evidence concerning blood testing of vitamin B12 and current clinical guidelines make no recommendations on the detection or prevention of vitamin B-12 deficiency during metformin treatment. Our objective was to examine the current practice and clinical determinants of vitamin B12 testing in metformin treated T2DM patients. Data were collected from health maintenance organization patients, and consisted of T2DM patients who were newly prescribed metformin from 2008 to 2013. Patients were randomly divided into two subgroups: referred for a vitamin B12 blood test, and did not receive a referral. The demographic data and medical characteristics were analyzed. 5131 patients began taking metformin during the study period. Of these 2332 (44.5 %) had vitamin B12 tested. Significant differences were found between the groups in regard to glycosylated hemoglobin, low density lipoprotein, systolic blood pressure, dyslipidemia, chronic renal failure, and disease duration. A significant positive association (p < .05) was found between vitamin B12 testing and insulin treatment, retinopathy, neuropathy and hypertension. Vitamin B12 in elderly (>75 years) patients was significantly lower (p < .01). Insulin treatment, hypertension, and chronic diabetic complications in metformin treated T2DM patients are associated with higher rates of vitamin B12 testing. T2DM patients 75 years and above were less likely to be tested for B12 deficiency.
血清维生素B12水平低在接受二甲双胍治疗的2型糖尿病（T2DM）患者中很常见。目前缺乏关于维生素B12血液检测的证据，现行临床指南也未就二甲双胍治疗期间维生素B-12缺乏的检测或预防提出建议。我们的目的是研究二甲双胍治疗的T2DM患者中维生素B12检测的当前实践和临床决定因素。数据收集自健康维护组织的患者，包括2008年至2013年新开具二甲双胍处方的T2DM患者。患者被随机分为两个亚组：被转诊进行维生素B12血液检测的，以及未接受转诊的。对人口统计学数据和医学特征进行了分析。5131名患者在研究期间开始服用二甲双胍。其中2332名（44.5%）进行了维生素B12检测。两组在糖化血红蛋白、低密度脂蛋白、收缩压、血脂异常、慢性肾功能衰竭和病程方面存在显著差异。维生素B12检测与胰岛素治疗、视网膜病变、神经病变和高血压之间存在显著正相关（p<0.05）。老年（>75岁）患者的维生素B12水平显著较低（p<0.01）。二甲双胍治疗的T2DM患者中，胰岛素治疗、高血压和慢性糖尿病并发症与维生素B12检测率较高相关。75岁及以上的T2DM患者接受维生素B12缺乏检测的可能性较小。
