Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
Eisai China Inc., Shanghai, China.
J Diabetes. 2019 Sep;11(9):729-743. doi: 10.1111/1753-0407.12900. Epub 2019 Mar 29.
Metformin is first-line therapy for patients with diabetes. However, it may lower vitamin B concentrations, which could have hematological or neurological implications. This meta-analyses reviewed all available studies on associations between metformin use and vitamin B levels, anemia, and neuropathy in diabetic patients.
PubMed, Web of Knowledge, Cochrane Library, and Embase were searched to identify all relevant studies published in English prior to March 2018. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for dichotomous outcomes and pooled mean differences (MDs) and 95% CIs were calculated for continuous outcomes.
Thirty-one studies were included in the meta-analyses. Compared with diabetic patients not taking metformin, patients taking metformin had a significantly higher risk of vitamin B deficiency (RR 2.09; 95% CI 1.49, 2.93; P < 0.0001; I = 64%) and significantly lower serum vitamin B concentrations (MD -63.70; 95% CI -74.35, -53.05] pM; P < 0.00001; I = 87%), which depended on dose and duration of treatment. Metformin use was also associated with significantly greater percentage decrease in serum vitamin B concentrations from baseline in diabetic patients (MD -14.68%; 95% CI -17.98%, -11.39%; P < 0.00001; I = 33%). Analyses revealed no significant association between metformin use and the prevalence of anemia or neuropathy.
Metformin use led to significantly lowered vitamin B concentrations and significantly higher risk of vitamin B deficiency in diabetic patients. More quality studies are needed to explore the associations between metformin use and anemia and neuropathy in these patients. Annual vitamin B assessment in diabetic patients taking metformin is recommended.
二甲双胍是糖尿病患者的一线治疗药物。然而，它可能会降低维生素 B 的浓度，从而对血液或神经系统产生影响。本荟萃分析综述了所有关于二甲双胍使用与糖尿病患者的维生素 B 水平、贫血和神经病变之间关系的研究。
检索了 PubMed、Web of Knowledge、Cochrane Library 和 Embase 数据库，以查找截至 2018 年 3 月发表的所有相关英文研究。对二分类结局计算合并风险比（RR）和 95%置信区间（CI），对连续性结局计算合并均数差值（MD）和 95%CI。
共纳入 31 项荟萃分析研究。与未服用二甲双胍的糖尿病患者相比，服用二甲双胍的患者维生素 B 缺乏的风险显著更高（RR 2.09；95%CI 1.49，2.93；P<0.0001；I 2 =64%），血清维生素 B 浓度显著更低（MD -63.70；95%CI -74.35，-53.05] pM；P<0.00001；I 2 =87%），且这种差异取决于治疗剂量和治疗时间。二甲双胍的使用还与糖尿病患者血清维生素 B 浓度从基线的显著下降相关（MD -14.68%；95%CI -17.98%，-11.39%；P<0.00001；I 2 =33%）。分析结果未显示二甲双胍的使用与贫血或神经病变的患病率之间存在显著关联。
二甲双胍的使用导致糖尿病患者的维生素 B 浓度显著降低，维生素 B 缺乏的风险显著增加。需要更多高质量的研究来探索这些患者中二甲双胍的使用与贫血和神经病变之间的关系。建议服用二甲双胍的糖尿病患者每年进行维生素 B 评估。
