title: Vitamin B12 screening in metformin-treated diabetics in primary care: were elderly patients less likely to be tested?
abstract: Low serum B12 level is a common occurrence in patients with type 2 diabetes (T2DM) treated with metformin. There is lack of evidence concerning blood testing of vitamin B12 and current clinical guidelines make no recommendations on the detection or prevention of vitamin B-12 deficiency during metformin treatment. Our objective was to examine the current practice and clinical determinants of vitamin B12 testing in metformin treated T2DM patients. Data were collected from health maintenance organization patients, and consisted of T2DM patients who were newly prescribed metformin from 2008 to 2013. Patients were randomly divided into two subgroups: referred for a vitamin B12 blood test, and did not receive a referral. The demographic data and medical characteristics were analyzed. 5131 patients began taking metformin during the study period. Of these 2332 (44.5 %) had vitamin B12 tested. Significant differences were found between the groups in regard to glycosylated hemoglobin, low density lipoprotein, systolic blood pressure, dyslipidemia, chronic renal failure, and disease duration. A significant positive association (p < .05) was found between vitamin B12 testing and insulin treatment, retinopathy, neuropathy and hypertension. Vitamin B12 in elderly (>75 years) patients was significantly lower (p < .01). Insulin treatment, hypertension, and chronic diabetic complications in metformin treated T2DM patients are associated with higher rates of vitamin B12 testing. T2DM patients 75 years and above were less likely to be tested for B12 deficiency.
authors.affiliation: Department of Family Practice, Leumit Health Maintenance Organization (HMO), Tel Aviv, Israel. yfogelman@gmail.com.|The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. yfogelman@gmail.com.
authors.forename: Yacov
authors.identifier: http://orcid.org/0000-0003-4067-4651
authors.initials: Y
authors.lastname: Fogelman
authors.affiliation: Department of Family Practice, Leumit Health Maintenance Organization (HMO), Tel Aviv, Israel.|Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
authors.forename: Eliezer
authors.initials: E
authors.lastname: Kitai
authors.affiliation: Department of Family Practice, Leumit Health Maintenance Organization (HMO), Tel Aviv, Israel.|Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
authors.forename: Gari
authors.initials: G
authors.lastname: Blumberg
authors.affiliation: Department of Family Practice, Leumit Health Maintenance Organization (HMO), Tel Aviv, Israel.|Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
authors.forename: Avivit
authors.initials: A
authors.lastname: Golan-Cohen
authors.affiliation: Department of Family Practice, Leumit Health Maintenance Organization (HMO), Tel Aviv, Israel.|Department of Medicine C and Diabetes Unit, Assaf Harofeh Medical Center, Tzrifin, Israel.
authors.forename: Micha
authors.initials: M
authors.lastname: Rapoport
authors.affiliation: Department of Physical Therapy, University of Haifa, Haifa, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Carmeli
mesh_terms: D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D007557:Israel / Q000453:epidemiology; D008297:Male; D008687:Metformin / Q000008:administration & dosage / Q000009:adverse effects; D011320:Primary Health Care / Q000379:methods; D012307:Risk Factors; D014805:Vitamin B 12 / Q000097:blood*; D014806:Vitamin B 12 Deficiency / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin; D014805:Vitamin B 12
keywords: Metformin-treated patients; Primary care physician; Vitamin B12 screening