title: Association Between Serum B12 and Serum Homocysteine Levels in Diabetic Patients on Metformin.
abstract: BACKGROUND
  Type-2 Diabetes Mellitus (T2DM) and metformin both can lower serum B12 (s.B12). Raised serum Homocysteine (s.Hcy) is considered as an early marker of B12 deficiency.
  
  
  OBJECTIVE
  The study aimed to check whether homocysteine levels are more sensitive indicator of s. B12 deficiency or not among diabetics using metformin.
  
  
  METHODS
  Mean s.B12 and s.Hcy levels of 30 cases (diabetics on metformin <5years) were compared with 30 diabetic controls not on metformin and 31 nondiabetic controls and statistically analysed by ANOVA and post-hoc tests.
  
  
  RESULTS
  No significant differences in either s.B12 mean or s.Hcy mean were found between cases and diabetic controls. s.B12 mean did not differ significantly but s.Hcy mean was significantly higher among nondiabetics as compared to diabetic control. s. B12 level of Nondiabetic group was in borderline category while mean s. B12 levels of cases and diabetic control groups was in normal category but nearer to the lower cut off. Mean s.Hcy values in all the groups were high. Pearson correlation showed strong association between s.B12 and s.Hcy in all the groups. Additionally equation based on linear regression was derived to calculate either of the s.B12 or s.Hcy. On Receiver Operative Characteristic (ROC) curve, area under curve value was 0.842 for the value of s.Hcy.
  
  
  CONCLUSIONS
  In this study neither metformin nor T2DM could be identified as a cause for s.B12 lowering and raised s.Hcy in the scenario of low normal levels of s.B12 (<300pmol/L). If B12 deficiency recognized early using s. Hcy, consequences due to B12 deficiency can be prevented or delayed among nondiabetics as well as among diabetics and metformin users.
authors.affiliation: Resident, Department of Biochemistry, H.M. Patel Centre for Medical Care and Education, Pamukh Swami Medical College and Shree Krishna Hospital , Karamsad, Gujarat, India .
authors.forename: Twinkal R
authors.initials: TR
authors.lastname: Upadhyay
authors.affiliation: Assistant Professor, Department of Pharmacology, Pacific Medical College and Hospital , Udaipur, Rajasthan, India .
authors.forename: Nitin
authors.initials: N
authors.lastname: Kothari
authors.affiliation: Professor, Department of Biochemistry, H.M. Patel Centre for Medical Care and Education, Pamukh Swami Medical College and Shree Krishna Hospital , Karamsad, Gujarat, India .
authors.forename: Hitesh
authors.initials: H
authors.lastname: Shah
keywords: Diabetes mellitus; Malabsorption; Serum B12 deficiency