Yazidi Meriem, Kamoun Elyes, Hadj Taieb Sameh, Rejeb Ons, Mahjoub Sonia, Maryam Sellami, Feki Moncef, Oueslati Ibtissem, Chihaoui Melika
Faculty of Medicine of Tunis, La Rabta Hospital, Department of Endocrinology, University of Tunis el manar, Tunis, Tunisia.
Faculty of Medicine of Tunis, La Rabta Hospital, Department of Biochemistry, University of Tunis el manar, Tunis, Tunisia.
Chronic Illn. 2024 Dec;20(4):631-639. doi: 10.1177/17423953231184220. Epub 2023 Jun 19.
To determine the prevalence of vitamin B12 deficiency in a Tunisian population with type 2 diabetes (T2D) on metformin treatment for more than three years and to identify its risk factors. This is a cross-sectional study conducted on 257 patients with T2D treated with metformin for at least three years. Patients were divided into two groups according to their vitamin B12 status. Low vitamin B12 was defined as ≤ 203 pg/mL. The mean age of the patients was 59.8 ± 7.9 years. The mean duration of metformin use was 10.2 ± 5.2 years. The mean vitamin B12 level was 294.9 ± 156.4 pg/mL. The prevalence of vitamin B12 deficiency was 28.4%. Male gender, HbA1c < 7% and hyperhomocysteinemia were significantly associated with vitamin B12 deficiency (respectively = 0.02, < 0.001, < 0.001). Homocysteine level was negatively correlated with vitamin B12 level ( = -0.2, = 0.001). Dose and duration of metformin treatment, peripheral neuropathy and anemia were not associated with vitamin B12 deficiency. On multivariate analysis, HbA1c < 7% and hyperhomocysteinemia were independently associated with vitamin B12 deficiency (respectively OR = 3.2, 95%CI = [1.6-6.3] and OR = 2.3, 95%CI = [1.2-4.2]). Discussion: The prevalence of vitamin B12 deficiency in patients with T2D on metformin treatment was high. Hyperhomocysteinemia is associated with vitamin B12 deficiency suggesting that the deficit occurs at the tissue level.
确定二甲双胍治疗三年以上的突尼斯2型糖尿病（T2D）患者中维生素B12缺乏症的患病率，并确定其危险因素。这是一项针对257例接受二甲双胍治疗至少三年的T2D患者进行的横断面研究。根据患者的维生素B12状态将其分为两组。维生素B12水平低定义为≤203 pg/mL。患者的平均年龄为59.8±7.9岁。二甲双胍的平均使用时间为10.2±5.2年。维生素B12的平均水平为294.9±156.4 pg/mL。维生素B12缺乏症的患病率为28.4%。男性、糖化血红蛋白（HbA1c）<7%和高同型半胱氨酸血症与维生素B12缺乏症显著相关（分别为P = 0.02、P<0.001、P<0.001）。同型半胱氨酸水平与维生素B12水平呈负相关（r = -0.2，P = 0.001）。二甲双胍治疗的剂量和持续时间、周围神经病变和贫血与维生素B12缺乏症无关。多因素分析显示，HbA1c<7%和高同型半胱氨酸血症与维生素B12缺乏症独立相关（分别为OR = 3.2，95%CI = [1.6 - 6.3]和OR = 2.3，95%CI = [1.2 - 4.2]）。讨论：接受二甲双胍治疗的T2D患者中维生素B12缺乏症的患病率较高。高同型半胱氨酸血症与维生素B12缺乏症相关，提示这种缺乏发生在组织水平。
