Department of Medicine and Geriatrics, Caritas Medical Centre (Hospital Authoirty), Wing Hong Street, Shum Shiu Po, Kowloon, Hong Kong, China.
Department of Medicine and Geriatrics, Caritas Medical Centre (Hospital Authoirty), Wing Hong Street, Shum Shiu Po, Kowloon, Hong Kong, China.
Arch Gerontol Geriatr. 2018 Nov-Dec;79:57-62. doi: 10.1016/j.archger.2018.07.019. Epub 2018 Jul 30.
Elderly people living in long term care institutions are particularly at risk of vitamin B deficiency. The prevalence of vitamin B deficiency was 34.9% among the 1996 institutionalized elderly residents in our previous study. The present retrospective study evaluated the association of metformin use with vitamin B deficiency in the same group of patients. Of 1996 patients, 507 (25.4%) had diabetes, of which 188 received metformin treatment. The prevalence of vitamin B deficiency in diabetic patients taking metformin was 53.2% compared with 31% (P < 0.001) of diabetic patients not taking metformin and 33.3% (P < 0.001) of those without diabetes. Among the vitamin B deficient patients, diabetic patients taking metformin had lower serum vitamin B concentration (97 pmol/L) than the diabetic patients not taking metformin (113 pmol/L, P < 0.001) and those without diabetes (111 pmol/L, P < 0.001). Subanalysis of 174 metformin users found that dose and duration of metformin use were significantly associated with vitamin B deficiency. Adjusted odds ratio for those taking metformin ≥1500 mg /day was 2.72 (95% CI 1.11-6.7, P = 0.029) compared with those using metformin <1000mg/day. Adjusted odds ratio for those taking metformin>4 years was 3.00 (95% CI 1.35-6.68, P = 0.007) compared with those taking metformin <2 years. Prevalence of vitamin B deficiency among those taking metformin ≥1500 mg/day for >2 years was 75.9% and was more than 2 times that of patients taking metformin <1500 mg/day for ≤2 years (35.3%). In conclusion, metformin use is associated with increased risk and severity of vitamin B deficiency in the institutionalized elderly residents. Patients taking metformin ≥1500 mg/day for >2 years are particularly at risk. Testing for vitamin B status before and regularly after the start of metformin may be considered.
长期护理机构中的老年人特别容易患维生素 B 缺乏症。在我们之前的研究中，1996 名机构内老年人居民的维生素 B 缺乏症患病率为 34.9%。本回顾性研究评估了二甲双胍在同一组患者中的使用与维生素 B 缺乏症之间的关联。在 1996 名患者中，507 名（25.4%）患有糖尿病，其中 188 名接受了二甲双胍治疗。服用二甲双胍的糖尿病患者中维生素 B 缺乏症的患病率为 53.2%，而未服用二甲双胍的糖尿病患者为 31%（P<0.001），无糖尿病的患者为 33.3%（P<0.001）。在维生素 B 缺乏症患者中，服用二甲双胍的糖尿病患者的血清维生素 B 浓度（97pmol/L）低于未服用二甲双胍的糖尿病患者（113pmol/L，P<0.001）和无糖尿病的患者（111pmol/L，P<0.001）。在 174 名二甲双胍使用者的亚组分析中，发现二甲双胍的剂量和使用时间与维生素 B 缺乏症显著相关。与每天使用二甲双胍<1000mg 的患者相比，每天使用二甲双胍≥1500mg 的患者的调整后比值比为 2.72（95%CI 1.11-6.7，P=0.029）。与使用二甲双胍<2 年的患者相比，使用二甲双胍>4 年的患者的调整后比值比为 3.00（95%CI 1.35-6.68，P=0.007）。每天使用二甲双胍≥1500mg 且使用时间超过 2 年的患者中，维生素 B 缺乏症的患病率为 75.9%，是每天使用二甲双胍<1500mg 且使用时间≤2 年的患者（35.3%）的两倍多。总之，二甲双胍的使用与长期护理机构中老年人维生素 B 缺乏症的风险和严重程度增加有关。每天使用二甲双胍≥1500mg 且使用时间超过 2 年的患者风险尤其高。在开始使用二甲双胍之前和之后定期检测维生素 B 状态可能是有必要的。
