Atkinson Michael, Gharti Prashamsa, Min Thinzar
Department of Diabetes and Endocrinology, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.
Diabetes Research Group, Swansea University Medical School, Swansea, UK.
touchREV Endocrinol. 2024 Oct;20(2):42-53. doi: 10.17925/EE.2024.20.2.7. Epub 2024 Jul 12.
Metformin is recommended as the first-line agent for the management of type 2 diabetes following lifestyle and dietary changes. The long-term use of metformin has been associated with vitamin B12 deficiency. The aim of this review is to investigate the effect of metformin on vitamin B12 levels and identify any risk factors. A literature search was conducted using MEDLINE, PubMed and ProQuest Central. Selected articles were peer-reviewed articles, written in English and published from 2015 and onwards. Excluded articles were case reports, reviews or meta-analyses, as well as those with no access to full text. In total, 21 articles were included. There was a significant association between metformin use and vitamin B12 levels in 17 studies, while 4 studies found no such association. The risk factors examined were metformin dose, treatment duration, patient age and patient ethnicity. In summary, metformin use was associated with lower vitamin B12 concentrations, and higher doses and longer durations of treatment increase the risk of vitamin B12 deficiency. Routine vitamin B12 screening is recommended, prioritizing higher-risk patients. Further research is needed to identify when to initiate monitoring.
在进行生活方式和饮食调整后，二甲双胍被推荐作为2型糖尿病管理的一线药物。长期使用二甲双胍与维生素B12缺乏有关。本综述的目的是研究二甲双胍对维生素B12水平的影响，并确定任何风险因素。使用MEDLINE、PubMed和ProQuest Central进行了文献检索。入选文章为同行评审文章，用英文撰写，发表于2015年及以后。排除的文章包括病例报告、综述或荟萃分析，以及无法获取全文的文章。总共纳入了21篇文章。17项研究发现二甲双胍的使用与维生素B12水平之间存在显著关联，而4项研究未发现这种关联。所研究的风险因素包括二甲双胍剂量、治疗持续时间、患者年龄和患者种族。总之，使用二甲双胍与较低的维生素B12浓度有关，较高的剂量和较长的治疗持续时间会增加维生素B12缺乏的风险。建议进行常规维生素B12筛查，优先考虑高风险患者。需要进一步研究以确定何时开始监测。
