Yousef Khan Fahmi, Yousif Abdelmonem B, Suliman Aasir, Saleh Ahmed Osman, Magdi Mohamed, Alshurafa Awni, Abdelmoneim Hassan Ebtihal, Ghazy Ahmed, Salameh Omar K, Abdallah Ahmed
Department of Medicine, Hamad General Hospital, Doha, Qatar E-mail:
Department of Pharmacy, Hamad General Hospital, Doha, Qatar.
Qatar Med J. 2021 Sep 9;2021(2):39. doi: 10.5339/qmj.2021.39. eCollection 2021.
Data on the effect of metformin on serum vitamin B12 (VitB12) level in patients with type 2 diabetes mellitus (T2DM) in Qatar are limited; therefore, we aimed to assess the prevalence of VitB12 deficiency and its related factors among patients with tbl2DM treated with metformin at Hamad General Hospital in Doha, Qatar, from January 1, 2017, to December 31, 2017.
This cross-sectional analytical study involved patients with tbl2DM aged ≥ 18 years who used metformin for at least 3 months. The serum VitB12 was quantified on a chemiluminescent enzyme immunoassay analyzer using Cobas e 801 module, Roche, and VitB12 deficiency was defined as serum VitB12 level of ≤ 145 pmol/L. All data were obtained from the patients' electronic medical records.
The study recruited 3124 eligible patients with tbl2DM. The overall prevalence of metformin-associated VitB12 deficiency was 30.7% [95% confidence of interval, 0.290-0.323]. A significant difference exists in the median VitB12 levels between the VitB12-normal and VitB12-deficient groups [129 vs. 286; p < 0.001]. Compared with the VitB12-normal group, the VitB12-deficient group had higher mean body mass index (BMI) ( < 0.001) and consumed higher doses of metformin ( = 0.001). They also more often used sulfonylurea ( = 0.004), dipeptidyl peptidase-4 inhibitor ( < 0.001), thiazolidinediones ( < 0.001), glucagon-like peptide 1 [GLP-1] receptor agonists ( < 0.001), alpha-glucosidase inhibitor ( < 0.001), and H2 blocker/proton pump inhibitors [PPI] ( < 0.001) than the VitB12-normal group. Moreover, the VitB12-normal group consumed more calcium supplements ( < 0.001) than the VitB12-deficient group. In the multivariate analysis, independent risk factors for metformin-associated VitB12 deficiency in patients with tbl2DM include high daily dose of metformin >2000 mg, male gender, high BMI, smoking, sulfonylurea, dipeptidyl peptidase-4 inhibitor, H2 blockers/PPI, low fasting blood glucose, and low hemoglobin.
This study showed a high prevalence of VitB12 deficiency in patients with tbl2DM taking metformin and a significant negative correlation between the daily dose of metformin and serum VitB12 level. Therefore, regular screening for serum VitB12 is necessary in patients with tbl2DM on metformin treatment, especially those who have the abovementioned risk factors.
卡塔尔2型糖尿病（T2DM）患者中二甲双胍对血清维生素B12（VitB12）水平影响的数据有限；因此，我们旨在评估2017年1月1日至2017年12月31日期间在卡塔尔多哈哈马德总医院接受二甲双胍治疗的T2DM患者中VitB12缺乏症的患病率及其相关因素。
这项横断面分析研究纳入了年龄≥18岁且使用二甲双胍至少3个月的T2DM患者。使用罗氏Cobas e 801模块在化学发光酶免疫分析仪上对血清VitB12进行定量，VitB12缺乏定义为血清VitB12水平≤145 pmol/L。所有数据均从患者的电子病历中获取。
该研究招募了3124例符合条件的T2DM患者。二甲双胍相关的VitB12缺乏症的总体患病率为30.7%[95%置信区间，0.290 - 0.323]。VitB12正常组和VitB12缺乏组之间的VitB12中位数水平存在显著差异[129对286；p < 0.001]。与VitB12正常组相比，VitB12缺乏组的平均体重指数（BMI）更高（p < 0.001），服用的二甲双胍剂量更高（p = 0.001）。他们还比VitB12正常组更常使用磺脲类药物（p = 0.004）、二肽基肽酶 - 4抑制剂（p < 0.001）、噻唑烷二酮类药物（p < 0.001）、胰高血糖素样肽1[GLP - 1]受体激动剂（p < 0.001）、α - 葡萄糖苷酶抑制剂（p < 0.001）以及H2受体阻滞剂/质子泵抑制剂[PPI]（p < 0.001）。此外，VitB12正常组比VitB12缺乏组摄入更多的钙补充剂（p < 0.001）。在多变量分析中，T2DM患者中二甲双胍相关的VitB12缺乏的独立危险因素包括每日高剂量二甲双胍>2000 mg、男性、高BMI、吸烟、磺脲类药物、二肽基肽酶 - 4抑制剂、H2受体阻滞剂/PPI、低空腹血糖和低血红蛋白。
本研究表明服用二甲双胍的T2DM患者中VitB12缺乏症的患病率很高，且二甲双胍的每日剂量与血清VitB12水平之间存在显著的负相关。因此，对于接受二甲双胍治疗的T2DM患者，尤其是那些具有上述危险因素的患者，定期筛查血清VitB12是必要的。
