Farland Michelle Z, McPheeters Chelsey M, Renwick Rachel C, Barlow Patrick B, Williams Juli D, Keeble Donald S, Franks Andrea S
University of Florida, Gainesville, FL, USA.
University of Tennessee, Knoxville, TN, USA.
J Pharm Technol. 2015 Aug;31(4):184-189. doi: 10.1177/8755122515576207. Epub 2015 Mar 9.
Metformin may cause vitamin B deficiency that can present with symptoms of peripheral neuropathy. Lack of vitamin B serum concentration monitoring could result in vitamin B deficiency progression, worsening of symptoms, and unnecessary medication. The purpose of this study was to () compare the influence of the rate of symptoms consistent with vitamin B deficiency on obtaining vitamin B serum concentrations in patients using metformin; () assess if vitamin B serum concentrations were ordered as a routine monitoring parameter. This retrospective case-control study evaluated patients receiving metformin. Patients in the case group had documented symptoms or diagnosis of peripheral neuropathy or macrocytic anemia, while those in the control group did not. The primary outcome was frequency of vitamin B serum concentration assessment. The secondary outcomes included frequency of vitamin B serum concentration assessment for patients presenting with symptoms or diagnosis of peripheral neuropathy or macrocytic anemia. Analysis included 355 patients (116 cases, 239 controls). The cases were 5 times more likely to have a serum vitamin B serum concentrations drawn versus controls (odds ratio [OR] = 5.83, 95% confidence interval [CI] = 3.47-9.77, < .001). Patients with a diagnosis of peripheral neuropathy or macrocytic anemia were 4 times more likely to have a serum vitamin B concentration drawn than those who did not (peripheral neuropathy: OR = 4.92, 95% CI = 2.95-8.21, < .001; macrocytic anemia: OR = 5.41, 95% CI = 1.30-20.97, = .007). Cases were more likely to have vitamin B serum concentrations assessed than patients without symptoms. The majority of patients taking metformin did not have routine vitamin B serum concentration assessments for medication adverse event monitoring.
二甲双胍可能导致维生素B缺乏，进而出现周围神经病变症状。缺乏血清维生素B浓度监测可能导致维生素B缺乏病情进展、症状加重以及不必要的用药。本研究的目的是：（）比较使用二甲双胍的患者中与维生素B缺乏相符的症状发生率对血清维生素B浓度检测的影响；（）评估血清维生素B浓度是否作为常规监测参数。这项回顾性病例对照研究对接受二甲双胍治疗的患者进行了评估。病例组患者有记录的周围神经病变或大细胞性贫血症状或诊断，而对照组患者没有。主要结局是血清维生素B浓度评估的频率。次要结局包括出现周围神经病变或大细胞性贫血症状或诊断的患者血清维生素B浓度评估的频率。分析纳入了355例患者（116例病例，239例对照）。病例组进行血清维生素B浓度检测的可能性是对照组的5倍（优势比[OR]=5.83，95%置信区间[CI]=3.47-9.77，P<.001）。诊断为周围神经病变或大细胞性贫血的患者进行血清维生素B浓度检测的可能性是未诊断患者的4倍（周围神经病变：OR=4.92，95%CI=2.95-8.21，P<.001；大细胞性贫血：OR=5.41，95%CI=1.30-20.97，P=.007）。有症状的病例组患者比无症状患者更有可能进行血清维生素B浓度评估。大多数服用二甲双胍的患者没有进行常规血清维生素B浓度评估以监测药物不良事件。
