title: Recommendations for diagnosis and management of metformin-induced vitamin B12 (Cbl) deficiency.
abstract: Metformin treatment is a known pharmacological cause of vitamin B12 (Cbl) deficiency with controversial responsible mechanisms. A possible diagnosis of this deficiency is based mainly on the combination of patient's medical history (usually long-term metformin use), clinical examination (possible neuropsychiatric symptoms and signs), laboratory studies which confirm a Cbl deficiency (haematological abnormalities, low serum Cbl levels, elevated serum total homocysteine and methylmalonic acid levels), and exclusion other causes of Cbl deficiency (as pernicious anaemia, food-cobalamin malabsorption syndrome, other drugs, etc.). In our review, recommendations for diagnosis and management of metformin-induced Cbl deficiency (MICD) in diabetic patients based on medical bibliography are presented and discussed.
authors: Department of Internal Medicine, Naval Hospital of Crete, 73 200 Chania, Crete, Greece. emazokopakis@yahoo.gr
authors: Elias E
authors: EE
authors: Mazokopakis
authors: Ioannis K
authors: IK
authors: Starakis
mesh_terms: D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D008687:Metformin / Q000009:adverse effects* / Q000627:therapeutic use; D008954:Models, Biological; D017410:Practice Guidelines as Topic; D015995:Prevalence; D014806:Vitamin B 12 Deficiency / Q000139:chemically induced* / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin