Association between Metformin, Vitamin B12 Supplements, and Vitamin B12 Deficiency in Type 2 Diabetic Adults: NHANES 1999-2006 Öffentlichkeit
Reinstatler, Lael Suzanne (2011)
Published
Abstract
Association between Metformin, Vitamin B12 Supplements, and
Vitamin B12 Deficiency in Type 2
Diabetic Adults: NHANES 1999-2006
Context
Metformin is currently recommended as the primary treatment for
diabetes and pre-
diabetes by the ADA. The association between metformin and vitamin
B12 levels has been documented
but knowledge regarding the attenuation of this relationship by
vitamin B12 supplements is lacking. This
information is especially important in older Americans who are at
greater risk for both diabetes and
vitamin B12 deficiency.
Objectives
To describe the prevalence of metformin associated vitamin B12
deficiency among US
adults over 50 with type 2 diabetes and how this relationship is
potentially modified by vitamin B12
supplements.
Design
Analysis of the nationally representative NHANES surveys from
1999-2006 of US adults over 50 who were either type 2 diabetic or
non-diabetic (n=1621,6851). Population prevalence calculations were
weighted according to
NHANES guidelines to represent the non-institutionalized US
population over 50.
Main Outcome Measurements Serum B12 levels were classified as
deficient at or below 148pmol/L and
borderline from 148 to 221 pmol/L.
Results Vitamin B12 deficiency was present in 5.5% of diabetics on
metformin and in 2.1% of diabetics
not on metformin (p<.05). Borderline B12 deficiency was found in
12.8% of diabetics on metformin and
in 6.1% of diabetics not on metformin (p<.01). A stratified
analysis based on B12 supplement use
indicated first, that taking B12 was protective against deficiency,
and second, that for diabetics on
metformin, a minimum of 100 µgs of B12 should be taken daily.
Metformin use was significantly
associated with serum B12 deficiency and borderline deficiency in a
logistic model adjusted for age,
race, sex, and antacid use by odds ratios of 2.73 (95% CI
1.20-6.18) and 2.20 (95% CI 1.22-3.99)
respectively.
Conclusion
Metformin use puts US adults over 50 at a greater risk for vitamin
B12 deficiency. This
risk is reduced by B12 supplement intake at levels of 100
micrograms per day or higher. Health care
providers should be aware of this relationship and serum B12 levels
should by monitored annually in
diabetics taking metformin while the recommendation to take
sufficient B12 supplements is made
evident.
Table of Contents
TABLE OF CONTENTS
Background
………………………………………………………..………….1
Abstract……………………………………………………..…………………
3
Introduction……………………………………………………………..……4
Methods………………………………………………………………………..6
Results………………………………………………………………………..…
9
Discussion………………………………………………………………………12
References…………………………………………………………………....15
Tables……………………………………………………………………………..17
Summary, Conclusions, Public Health Implications
………..47
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