title: Sublingual vitamin B12 compared to intramuscular injection in patients with type 2 diabetes treated with metformin: a randomised trial.
abstract: MAIM: To compare a single 1mg intramuscular hydroxocobalamin injection with a 3-month course of 1mg/day sublingual methylcobalamin supplements on serum vitamin B12 concentrations in participants withtype 2 diabetes treated with metformin.
  
  
  METHODS
  Participants on metformin treatment with vitamin B12 concentrations below 220pmol/L were recruited through hospital diabetes clinics and primary care practices. They were randomised to receive either the injection or sublingual treatment. The primary outcome was serum vitamin B12 level after 3 months adjusted for baseline assessed by analysis of covariance (ANCOVA). The trial was registered on the Australia New Zealand Clinical Trial registry (ACTRN12612001108808).
  
  
  RESULTS
  A total of 34 participants were randomised; 19 to the tablet, and 15 to the injection. The mean (SD) age, duration of diabetes, and duration of metformin use were, 64.2 (7.3) years, 13.7 (6.4) years, and 11.6 (5.0) years, respectively. After 3 months, the mean (SD) vitamin B12 was 372.1 (103.3) pmol/L in the tablet group (n=19) compared to 251.7 (106.8) pmol/L in the injection group (n=15), ANCOVA estimated difference -119.4 (95% CI -191.2 to -47.6), p=0.002. After 6 months, the mean (SD) serum B12 was 258.8 (58.7) pmol/L in the tablet group (n=17) and 241.9 (40.1) pmol/L in the injection group (n=15); ANCOVA estimated difference -15.2 (95% CI -50.3 to 19.8), p=0.38. Higher metformin dose was associated with lower serum B12 at 3 months, but not at baseline or 6 months.
  
  
  CONCLUSIONS
  Decreased serum vitamin B12 level in patients with type 2 diabetes who are treated with metformin can be corrected through treatment with either hydroxocobalamin injections or methylcobalamin sublingual supplements.
authors.affiliation: Centre for Endocrine, Diabetes and Obesity Research, Capital and Coast Health, Private Bag 7902, Wellington, New Zealand. amber.parry-strong@ccdhb.org.nz.
authors.forename: Amber
authors.initials: A
authors.lastname: Parry-Strong
authors.affiliation: Department of Obstetrics and Gynaecology, Christchurch Women's Hospital, Christchurch. monique.stravens@cdhb.health.nz.
authors.forename: Fali
authors.initials: F
authors.lastname: Langdana
authors.forename: Sylvan
authors.initials: S
authors.lastname: Haeusler
authors.forename: Mark
authors.initials: M
authors.lastname: Weatherall
authors.forename: Jeremy
authors.initials: J
authors.lastname: Krebs
mesh_terms: D000286:Administration, Sublingual; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007273:Injections, Intramuscular; D008297:Male; D008687:Metformin / Q000009:adverse effects*; D008875:Middle Aged; D009520:New Zealand; D016896:Treatment Outcome; D014805:Vitamin B 12 / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000097:blood; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy*; D014803:Vitamin B Complex / Q000008:administration & dosage*
chemical_list: D007004:Hypoglycemic Agents; D014803:Vitamin B Complex; D008687:Metformin; C019476:mecobalamin; D014805:Vitamin B 12