Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
Clinical Biochemistry and Psychopharmacology Research Unit, Department of Biochemistry, University of Karachi, Karachi, Pakistan.
BMJ Open Diabetes Res Care. 2020 May;8(1). doi: 10.1136/bmjdrc-2019-001151.
To assess the prevalence of vitamin B deficiency in people with type 2 diabetes mellitus (T2DM) on metformin and without metformin.
Between May 2018 and January 2019, this prospective multicenter observational study recruited participants from seven centers in four provinces of Pakistan (Sindh, Punjab, Baluchistan and Khyber Pakhtunkhwa). Participants with T2DM treated with metformin for >2 years and those not on metformin underwent assessment of hemoglobin, vitamin B, homocysteine and diabetic neuropathy (vibration perception threshold (VPT) >15V) and painful diabetic neuropathy (Douleur Neuropathique 4 (DN4) ≥4) and Diabetic Neuropathy Symptom (DNS) score ≥1.
Of 932 subjects, 645 (69.2%) were treated with metformin, while 287 (30.8%) were not on metformin. Overall, B deficiency (<200 pg/mL) was significantly higher in metformin users of 25 (3.9%), compared with non-metformin users of 6 (2.1%), while B insufficiency (200-300 pg/mL) was significantly lower in metformin users of 117 (18.4%) compared with non-metformin users of 80 (27.9%). Subjects with B deficiency and insufficiency with hyperhomocysteinemia (≥15) were found in 19 (76%) µmol/L and 69 (60.5%) µmol/L in metformin users compared with 6 (100%) µmol/L and 57 (73.1%) μmol/L in non-metformin users, respectively. VPT>25 and DN4 score ≥4 were significantly higher in B-deficient metformin users compared with non-metformin users. Similarly, DNS score ≥1 was non-significantly higher in B-deficient metformin users compared with non-metformin users.
This study shows that vitamin B insufficiency was frequently found in our population and may progress into B deficiency. It is also associated with neuropathy in subjects on metformin. Further interventional studies to assess the benefit of B treatment on painful neuropathy in patients on metformin may be warranted. B levels may be checked in people with T2DM using metformin for >2 years.
评估使用二甲双胍和未使用二甲双胍的 2 型糖尿病（T2DM）患者中维生素 B 缺乏的流行情况。
在 2018 年 5 月至 2019 年 1 月期间，这项前瞻性多中心观察性研究从巴基斯坦四个省（信德省、旁遮普省、俾路支省和开伯尔-普赫图赫瓦省）的七个中心招募了参与者。使用二甲双胍治疗超过 2 年的 T2DM 患者和未使用二甲双胍的患者接受了血红蛋白、维生素 B、同型半胱氨酸和糖尿病神经病变（振动感觉阈值（VPT）>15V）和疼痛性糖尿病神经病变（DN4≥4）和糖尿病神经病变症状（DNS）评分≥1 的评估。
在 932 名受试者中，645 名（69.2%）使用二甲双胍治疗，287 名（30.8%）未使用二甲双胍。总体而言，使用二甲双胍的患者中 B 缺乏症（<200pg/mL）的发生率明显高于未使用二甲双胍的患者（3.9%比 2.1%），而 B 不足症（200-300pg/mL）的发生率明显低于未使用二甲双胍的患者（18.4%比 27.9%）。在使用二甲双胍的患者中，有 19 名（76%）µmol/L 和 69 名（60.5%）µmol/L 的患者出现高同型半胱氨酸血症（≥15），而在未使用二甲双胍的患者中，有 6 名（100%）µmol/L 和 57 名（73.1%）µmol/L 的患者出现高同型半胱氨酸血症（≥15）。在 B 缺乏的使用二甲双胍的患者中，VPT>25 和 DN4 评分≥4 的比例明显高于未使用二甲双胍的患者。同样，在 B 缺乏的使用二甲双胍的患者中，DNS 评分≥1 的比例也高于未使用二甲双胍的患者，但差异无统计学意义。
本研究表明，在我们的人群中，维生素 B 不足的情况很常见，并且可能发展为 B 缺乏症。它也与使用二甲双胍的患者的神经病变有关。可能需要进一步的干预研究来评估在使用二甲双胍的患者中补充 B 对疼痛性神经病变的益处。对于使用二甲双胍超过 2 年的 T2DM 患者，可以检查 B 水平。
