Alshammari Amal N, Iqbal Rafay, Baksh Iqra Peer
Department of Family and Community Medicine, Joint Program, Riyadh, Saudi Arabia.
Department of Dermatology, General Practitioner, Riyadh, Saudi Arabia.
J Family Med Prim Care. 2019 Jul;8(7):2306-2311. doi: 10.4103/jfmpc.jfmpc_416_19.
BACKGROUND/AIM: The worldwide prevalence of diabetes is high including Saudi Arabia. One standard first-line treatment for diabetes is metformin, which was reported to increase the risk for vitamin B12 deficiency. We wanted to determine the prevalence of vitamin B12 deficiency in metformin-treated type 2 diabetes mellitus patients.
We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. Type 2 diabetes mellitus patients who were on metformin for at least 1 year were included in the study. Associations between B12 deficiency and age, duration of type 2 diabetes mellitus (T2DM), duration of use and dosage of metformin, and use of proton pump inhibitors (PPIs) were determined.
Of 363 T2DM patients, 206 (56.7%) were males and 157 (43.3%) were females, mean age was 53.72 ± 11.31 years, the mean duration of T2DM was 9.89 ± 7.32 years, and the mean duration of metformin use was 9.84 ± 7.29 years. There were 205 patients 56.5% who had a daily dose of 750 mg of metformin. The most commonly used oral hypoglycemic agent was gliclizide only in 138 (38.4%) of patients. There were 107 patients (29.5%) who were on PPIs. There were 210 patients (57.9%) who were on vitamin B12 supplementation, of which 111 (30.6%) had a daily dose of 200 mcg. The use of vitamin B12 supplement, duration of T2DM and duration of metformin use was significantly higher among females. The use of vitamin B12 supplement was significant among patients who were 46 years old and above. There were only 16 patients (4.4%) who had available serum vitamin B12 levels. Only 44.0% of the physician respondents know the current recommendation of American Diabetes Association on vitamin B12 screening and supplementation among diabetic patients, and 21.0% never prescribe vitamin B12 to their patients.
Routine testing for serum vitamin B12 level is not practiced in our institution. A large percentage of physicians are not aware of the current recommendations of the American Diabetic Association (ADA) regarding vitamin B12 supplementation and screening. Thus, there is a need for doctors involved in the management of diabetes to keep abreast with guidelines and current recommendations and routinely monitor vitamin B12 levels particularly those who were on long-term takers of metformin and the elderly patients to optimize management of diabetes and its complications.
背景/目的：糖尿病在全球包括沙特阿拉伯的患病率都很高。糖尿病的一种标准一线治疗药物是二甲双胍，据报道其会增加维生素B12缺乏的风险。我们想确定二甲双胍治疗的2型糖尿病患者中维生素B12缺乏的患病率。
我们在沙特阿拉伯利雅得的四家医院的糖尿病诊所进行了一项横断面研究。研究纳入了服用二甲双胍至少1年的2型糖尿病患者。确定了维生素B12缺乏与年龄、2型糖尿病（T2DM）病程、二甲双胍使用时间和剂量以及质子泵抑制剂（PPI）使用之间的关联。
在363例T2DM患者中，206例（56.7%）为男性，157例（43.3%）为女性，平均年龄为53.72±11.31岁，T2DM的平均病程为9.89±7.32年，二甲双胍的平均使用时间为9.84±7.29年。有205例患者（56.5%）每日服用750毫克二甲双胍。最常用的口服降糖药仅格列齐特在138例（38.4%）患者中使用。有107例患者（29.5%）正在服用PPI。有210例患者（57.9%）正在补充维生素B12，其中111例（30.6%）每日剂量为200微克。女性中维生素B12补充剂的使用、T2DM病程和二甲双胍使用时间显著更高。46岁及以上患者中维生素B1补充剂的使用显著。只有16例患者（4.4%）有可用的血清维生素B12水平。只有44.0%的医生受访者知道美国糖尿病协会目前关于糖尿病患者维生素B12筛查和补充的建议，21.0%的医生从未给他们的患者开维生素B12。
我们机构未进行血清维生素B12水平的常规检测。很大比例的医生不了解美国糖尿病协会（ADA）目前关于维生素B12补充和筛查的建议。因此，参与糖尿病管理的医生需要跟上指南和当前建议，并常规监测维生素B12水平，特别是那些长期服用二甲双胍的患者和老年患者，以优化糖尿病及其并发症的管理。
