Ts Rathis, Ranganathan Rangabashyam Seetharaman, Solai Raja Moogaambiga, Srivastav Pillutla Sai Sareen
General Medicine, Vinayaka Mission Kirupananda Variyar Medical College and Hospital, Salem, IND.
Internal Medicine, Vinayaka Mission Kirupananda Variyar Medical College and Hospital, Salem, IND.
Cureus. 2023 Apr 12;15(4):e37466. doi: 10.7759/cureus.37466. eCollection 2023 Apr.
Background Long-term metformin treatment in individuals with type 2 diabetes mellitus causes vitamin B12 insufficiency, which is typically neglected, undetected, and under-treated. A severe deficit may cause life-threatening neurological problems. This study assessed the prevalence of vitamin B12 deficiencies among T2DM patients and its factors at a tertiary hospital in the Tamil Nadu district of Salem. Materials and Methods This is an analytical cross-sectional study conducted in a tertiary care hospital in the Salem district, Tamil Nadu, India. Patients with type 2 diabetes mellitus who were prescribed metformin at the outpatient department of general medicine took part in the trial. Our research instrument was a structured questionnaire. We used a questionnaire containing information on sociodemographic characteristics, metformin use among diabetic mellitus patients, diabetes mellitus history, lifestyle behaviors, anthropometric measurement, examination findings, and biochemical markers. Prior to administering the interview schedule, each participant's parents provided written informed consent. A thorough medical history, physical exam, and anthropometric examination were performed. Data were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed using SPSS version 23 (IBM Corp., Armonk, NY). Results Among the study participants, we diagnosed nearly 43% of diabetes cases in participants between the ages of 40-50 years, while we diagnosed 39% aged under 40 years. Nearly 51% had diabetes for 5-10 years, while only 14% had diabetes for over 10 years. In addition, 25% of the study sample had a positive family history of type 2 diabetes. Nearly 48% and 13% of the study group had been on metformin for 5-10 years and >10 years, respectively. The majority, 45%, were found to take 1000 mg of metformin per day, whereas just 15% take 2 g per day. In our study, the prevalence of vitamin B12 insufficiency was 27%, and nearly 18% had borderline levels. The duration of diabetes mellitus, the duration of metformin intake, and the dose of metformin were statistically significant (p-value = 0.05) among the variables associated with diabetes mellitus and vitamin B12 deficiency. Conclusion The results of the study show that a deficiency in vitamin B12 increases the likelihood that diabetic neuropathy would worsen. Therefore, individuals with diabetes who take larger dosages of metformin (more than 1000mg) for an extended period must have their vitamin B12 levels monitored often. Preventative or therapeutic vitamin B12 supplementation can mitigate this issue.
2型糖尿病患者长期服用二甲双胍会导致维生素B12缺乏，而这种情况通常被忽视、未被检测到且治疗不足。严重缺乏可能会导致危及生命的神经问题。本研究评估了印度泰米尔纳德邦塞勒姆地区一家三级医院中2型糖尿病患者维生素B12缺乏的患病率及其影响因素。
这是一项在印度泰米尔纳德邦塞勒姆地区一家三级护理医院进行的分析性横断面研究。在普通内科门诊被开具二甲双胍的2型糖尿病患者参与了该试验。我们的研究工具是一份结构化问卷。我们使用了一份包含社会人口学特征、糖尿病患者二甲双胍使用情况、糖尿病病史、生活方式行为、人体测量、检查结果和生化指标等信息的问卷。在实施访谈时间表之前，每位参与者的父母都提供了书面知情同意书。进行了全面的病史、体格检查和人体测量检查。数据录入Microsoft Excel（微软公司，华盛顿州雷德蒙德），并使用SPSS 23版（IBM公司，纽约州阿蒙克）进行分析。
在研究参与者中，我们在40 - 50岁的参与者中诊断出近43%的糖尿病病例，而在40岁以下的参与者中诊断出39%。近51%的人患糖尿病5 - 10年，而只有14%的人患糖尿病超过10年。此外，25%的研究样本有2型糖尿病家族史阳性。近48%和13%的研究组分别服用二甲双胍5 - 10年和超过10年。大多数人（45%）每天服用1000毫克二甲双胍，而只有15%的人每天服用2克。在我们的研究中，维生素B12缺乏的患病率为27%，近18%处于临界水平。糖尿病病程、二甲双胍摄入时间和二甲双胍剂量在与糖尿病和维生素B12缺乏相关的变量中具有统计学意义（p值 = 0.05）。
研究结果表明，维生素B12缺乏会增加糖尿病神经病变恶化的可能性。因此，长期服用大剂量（超过1000毫克）二甲双胍的糖尿病患者必须经常监测其维生素B12水平。预防性或治疗性补充维生素B12可以缓解这个问题。
