Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Metformin Kullanan Tip 2 Diyabetli Bireylerde B12 Vitamin Eksikliğinin Belirlenmesi
Determination of Vitamin B12 Deficiency in Patients with Metformin Using Type 2 Diabetes
Hatice BEYAZAL POLATa, Teslime AYAZa
aİç Hastalıkları ABD, Recep Tayyip Erdoğan Üniversitesi Tıp Fakültesi, Rize, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2019;4(3):237-41
doi: 10.5336/healthsci.2018-63294
Article Language: TR
Full Text
ÖZET
 ÖZET Amaç: Metformin, Tip 2 diyabet (DM) tedavisinde birinci basamak tedavi olarak tüm dünyada kullanılmaktadır. Metforminin en sık yan etkisi gastrointestinal sistem ile ilgili ishal, karında rahatsızlık hissidir. Sürekli kullanımda B12 vitamininin emilimini azaltabilmektedir. Bu çalışma metformin kullanan Tip 2 DM hastalarında B12 vitamin eksikliği sıklığını belirlemek amacıyla yapılmıştır. Gereç ve Yöntemler: Ocak 2016-Aralık 2017 tarihleri arasında, iç hastalıkları polikliniğinde takip edilen, metformin kullanan Tip 2 DM tanılı 159 hasta retrospektif olarak değerlendirilmiştir. Hastaların demografik özellikleri, kullandıkları tedaviler, metformin dozları, B12 vitamin düzeyleri ve hemogram değerleri sorgulanmış elde edilen veriler değerlendirilmiştir. Hastalar, kullandıkları metformin dozuna göre 3 gruba ayrılmış, birinci grupta 1.000 mg/gün, ikinci grupta 1.700 mg/gün ve üçüncü grupta 2.000 mg/gün metformin kullanan hastalar yer almıştır. Verilerin istatistiksel analizi SPSS 15.0 paket programı kullanılarak yapılmıştır. Bulgular: Çalışmaya, metformin kullanan toplam 159 hasta dâhil edilmiştir. Metformin kullanan DM'li hastaların %18,2'sinde B12 vitamin eksikliği tespit edilmiştir. B12 vitamin eksikliği günlük alınan metformin dozları ile değerlendirildiğinde, 1.000 mg/dL metformin kullanan hastalara göre 2.000 mg/gün metformin kullanan hastalarda vitamin B12 eksikliği istatistiksel olarak anlamlı olduğu görülmüştür (p=0,020). Sonuç: Metformin, diyabetik hastalarda B12 vitamini emilimini engelleyerek B12 vitamin eksikliğine neden olabilir. Bu çalışmada, metformin kullanan DM'li hastaların önemli bir kısmında B12 vitamin eksikliği olduğu bulunmuştur. Metformin kullanan DM'li hastaların takibinde B12 vitamin düzeylerinin düzenli olarak izlenmesi gerekir. Özellikle yüksek doz metformin kullanan hastalarda B12 vitamin eksikliği açısından daha dikkatli olunması gerekmektedir.

Anahtar Kelimeler: Diabetes mellitus; metformin; B12 vitamini eksikliği
ABSTRACT
 Objective: Metformin is used worldwide as the first-line therapy in the treatment of Type 2 diabetes (DM). The most common side effect of metformin is gastrointestinal system diarrhea, abdominal discomfort. It can reduce the absorption of vitamin B12 in continuous use. This study was conducted to determine the frequency of vitamin B12 deficiency in Type 2 DM patients using metformin. Material and Methods: A total of 159 patients diagnosed with Type 2 DM using metformin were evaluated retrospectively between January 2016-December 2017 in the internal medicine outpatient clinic. Demographic characteristics, metformin doses, vitamin B12 levels and hemogram values of the patients were evaluated. Patients were divided into 3 groups according to the metformin dose they used, in the first group were 1.000 mg/day, in the second group 1.700 mg/day and in the third group 2.000 mg/day metformin patients. Statistical analysis of the data was done using SPSS 15.0 package program. Results: A total of 159 patients using metformin were included in the study. B12 vitamin deficiency was detected in 18.2% of DM patients using metformin. Vitamin B12 deficiency was found to be statistically significant in patients who received 2.000 mg/day of metformin when compared with patients receiving 1.000 mg/dL metformin when vitamin B12 deficiency was evaluated with daily metformin doses (p=0.020). Conclusion: Metformin may cause vitamin B12 deficiency by preventing the absorption of vitamin B12 in diabetic patients. In this study, vitamin B12 deficiency was found in a significant number of DM patients using metformin. Vitamin B12 levels should be monitored regularly in the follow-up of DM patients using metformin. Patients with high dose metformin should be treated more carefully in terms of vitamin B12 deficiency.

Keywords: Diabetes mellitus; metformin; vitamin B12 deficiency
REFERENCES:
  1. Saenz A, Fernandez-Esteban I, Mataix A, Ausejo Segura M, Roque i Figuls M, Moher D. WITHDRAWN: Metformin monotherapy for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2015;30(9):CD002966. [Crossref]  [PubMed] 
  2. Scarpello JHB. Review: Optimal dosing strategies for maximising the clinical response to metformin in type 2 diabetes. Br J Diabetes Vasc Dis. 2001;1:28-36. [Crossref] 
  3. Bailey CJ, Wilcock C, Scarpello JH. Metformin and the intestine. Diabetologia. 2008;51(8):1552-3. [Crossref] 
  4. DeFronzo RA, Goodman AM. Efficvacy of metformin in patients with non-insulin-dependent diabetes mellitus. The Muticenter Metformin Study Group. N Eng J Med. 1995;333(9):541-9. [Crossref]  [PubMed] 
  5. Andres E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency. Arch Intern Med. 2002;162(19):2251-2. [Crossref]  [PubMed] 
  6. Ocakci S. [Approach to iron and B12 deficiency anemia in primary care]. Smyrna Tip Derg. 2012;51-3.
  7. Tavares Bello C, Capitao RM, Sequeira Duarte J, Azinheira J, Vasconcelos C. [Vitamin B12 deficiency in type 2 diabetes mellitus]. Acta Med Port. 2017;30(10):719-26. [Crossref]  [PubMed] 
  8. Chen S, Lansdown AJ, Moat SJ, Ellis R, Goringe A, Dunstan FDJ, et al. An observational study of the effect of metformin on B12 status and peripheral neuropathy. British J Diabetes Vascular Dis. 2012;12:189-93. [Crossref] 
  9. Filioussi K, Bonovas S, Katsaros T. Should we screen diabetes patients using biguanides for megaloblastic anemia? Aust Fam Physician. 2003;32(5):383-4.
  10. Wulffele MG, Kooy A, Lehert P, Bets D, Ogterop JC, Borger van der Burg B, et al. Effects of short-term treatment with metformin on serum concentrations of homocysteine, folate and vitamin B12 in type 2 diabetes mellitus: a randomized, placebo-controlled trial. J Inter Med. 2003;254(5):455-63. [Crossref]  [PubMed] 
  11. Tomkin GH, Hadden DR, Weaver JA, Montgomery DA. Vitamin-B12 status of patients on long-term metformin therapy. Br Med J. 1971;2(5763):685-7. [Crossref]  [PubMed]  [PMC] 
  12. Niafar M, Hai F, Porhomayon J, Nader DN. The role of metformin on vitamin B12 deficiency: a meta-analysis review. Intern Emerg Med. 2015;10(1):93-102. [Crossref]  [PubMed] 
  13. Ko SH, Ko SH, Ahn YB, Song KH, Han KD, Park YM, et al. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. J Korean Med Sci. 2014;29(7):965-72. [Crossref]  [PubMed]  [PMC] 
  14. Viollet B, Guigas B, Sanz Garcia N, Leclerc J, Foretz M, Andreelli F. Cellular and molecular mechanisms of metformin: an overview. Clin Sci (Lond). 2012;122(6):253-70. [Crossref]  [PubMed]  [PMC] 
  15. Ting RZ, Szeto CC, Chan MH, Ma KK, Chow KM. Risk factors of vitamin B(12) deficiency in patients receiving metformin. Arch Intern Med. 2006;166(18):1975-9. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com