title: Prevalence of vitamin B12 deficiency in type 2 diabetic patients using metformin: a cross-sectional study.
abstract: The prevalence of vitamin B12 deficiency varies from 5.8% to 30% among patients undergoing long-term treatment with metformin. Because of the paucity of data on Brazilian patients, this study aimed to determine the frequency of B12 deficiency and related factors among Brazilian patients with type 2 diabetes mellitus (T2DM) using metformin.
  Cross-sectional study at a public university hospital.
  Patients with T2DM and a control group of non-diabetics were included. Serum B12 levels were measured and biochemical B12 deficiency was defined as serum levels < 180 pg/ml. Associations between B12 deficiency and age, duration of T2DM, duration of use and dosage of metformin, and use of proton pump inhibitors (PPIs) or histamine H2 antagonists were determined.
  231 T2DM patients using metformin (T2DM-met) and 231 controls were included. No difference in the frequency of PPI or H2-antagonist use was seen between the groups. B12 deficiency was more frequent in the T2DM-met group (22.5% versus 7.4%) and this difference persisted after excluding PPI/H2-antagonist users (17.9% versus 5.6%). The factors that interfered with serum B12 levels were PPI/H2-antagonist use and duration of metformin use ≥ 10 years. Use of PPI/H2-antagonists was associated with B12 deficiency, with an odds ratio of 2.60 (95% confidence interval, 1.34-5.04).
  Among T2DM patients, treatment with metformin and concomitant use of PPI/H2-antagonists are associated with a higher chance of developing B12 deficiency than among non-diabetics.
authors.affiliation: MD. Master's Student, Department of Internal Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil.
authors.forename: Charbel Pereira
authors.initials: CP
authors.lastname: Damião
authors.affiliation: MD. Attending Physician, Department of Internal Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil.
authors.forename: Amannda Oliveira
authors.initials: AO
authors.lastname: Rodrigues
authors.affiliation: MD, PhD. Attending Physician, Division of Endocrinology, Diagnósticos da América, Rio de Janeiro, RJ, Brazil.
authors.forename: Maria Fernanda Miguens Castellar
authors.initials: MF
authors.lastname: Pinheiro
authors.affiliation: MD, PhD. Associate Professor, Department of Internal Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil.
authors.forename: Rubens Antunes da
authors.initials: RA
authors.lastname: Cruz
authors.affiliation: MD, PhD. Associate Professor, Department of Internal Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil.
authors.forename: Gilberto Peres
authors.initials: GP
authors.lastname: Cardoso
authors.affiliation: MD, PhD. Adjunct Professor, Department of Internal Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil.
authors.forename: Giselle Fernandes
authors.initials: GF
authors.lastname: Taboada
authors.affiliation: MD, PhD. Adjunct Professor, Department of Internal Medicine, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil.
authors.forename: Giovanna Aparecida Balarini
authors.initials: GA
authors.lastname: Lima
mesh_terms: D000368:Aged; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006635:Histamine H2 Antagonists / Q000009:adverse effects; D006779:Hospitals, Public; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008687:Metformin / Q000009:adverse effects*; D008875:Middle Aged; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014805:Vitamin B 12 / Q000097:blood; D014806:Vitamin B 12 Deficiency / Q000139:chemically induced* / Q000453:epidemiology*
chemical_list: D006635:Histamine H2 Antagonists; D007004:Hypoglycemic Agents; D054328:Proton Pump Inhibitors; D008687:Metformin; D014805:Vitamin B 12