Metformin Use and Vitamin B12 Deficiency: Untangling the Association

• Published in: The American journal of the medical sciences Vol. 354; no. 2; pp. 165 - 171
• Main Authors: Rodríguez-Gutiérrez, René, Montes-Villarreal, Juan, Rodríguez-Velver, Karla Victoria, González-Velázquez, Camilo, Salcido-Montenegro, Alejandro, Elizondo-Plazas, Anasofia, González-González, José Gerardo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2017
• Subjects: Adolescent; Adult; Aged; Cross-Sectional Studies; Cyanocobalamin-deficiency; Diabetes Mellitus, Type 2 - drug therapy; Female; Humans; Hypoglycemic Agents - adverse effects; Male; Metformin; Metformin - adverse effects; Metformin - therapeutic use; Middle Aged; Type 2 diabetes; Vitamin B 12 - blood; Vitamin B 12 Deficiency - blood; Vitamin B 12 Deficiency - chemically induced; Vitamin B12 deficiency; Young Adult; Type 2 diabetes; Metformin; Vitamin B12 deficiency; Cyanocobalamin-deficiency
• ISSN: 0002-9629; 1538-2990
• DOI: 10.1016/j.amjms.2017.04.010

Current evidence linking vitamin B12 deficiency with metformin use is inconsistent. Hence, there is uncertainty regarding the diagnostic approach in this scenario. Furthermore, this possible association has not been studied in the complete spectrum of patients with diabetes.
We conducted a cross-sectional, controlled study with the objective of assessing differences in serum vitamin B12 levels among patients with and without diabetes with different metformin-treatment regimens. A total of 150 participants were recruited: patients with diabetes (group 1: metformin alone ≥850mg/day, group 2: patients with type 2 diabetes naive to treatment and group 3: metformin ≥850mg/day, in addition to any other oral glucose lowering agent or insulin, or both) and without diabetes (group 4: polycystic ovary syndrome or group 5: healthy individuals). Serum vitamin B12, folate levels and complete blood counts were obtained for the entire population. Methylmalonic acid and homocysteine were obtained for patients when vitamin B12 levels were found to be borderline or low.
When patients with or without diabetes were compared, no significant difference was found in relation to their vitamin B12 levels (517.62 versus 433.83; P = 0.072). No difference in vitamin B12 levels was found among participants with metformin use and metformin naive participants (503.4 versus 462.3; P = 0.380).
Irrespective of metformin use, no significant difference in the serum levels of vitamin B12 was observed, both in patients with and without diabetes. In the light of the body of evidence and the results of this study, a universal recommendation for vitamin B12 deficiency screening cannot be made.