Recent evidence has emerged about metformin use and vit. B12 deficiency. This was reported in Arc Intern Med recently by Hongkong based researchers.

Dr. Rose Zhao-Wei Ting from Prince of Wales Hospital and team monitored 155 cases of DM and vitamin B12 deficiency secondary to metformin treatment, as well as 310 controls who did not have vitamin B12 deficiency while taking metformin.

In the patients with metformin-related vitamin B12 deficiency, mean serum vitamin B12 concentration was 148.6 ± 40.4 pg/mL (110 ± 30 pmol/L) compared with 466.1 ± 330.4 pg/mL (344 ± 244 pmol/L) in the controls. After adjustment for confounders, there were clinically important and statistically significant associations of vitamin B12 deficiency with dose and duration of metformin use. Each 1-g/day increment in metformin dose conferred an odds ratio of 2.88 (95% confidence interval [CI], 2.15 - 3.87) of developing vitamin B12 deficiency (P < .001).

Compared with those receiving metformin for less than 3 years, the adjusted odds ratio was 2.39 (95% CI, 1.46 - 3.91) for those using metformin for 3 years or more (P = .001). After excluding 113 subjects with borderline vitamin B12 concentration, the metformin dose remained the strongest independent predictor of vitamin B12 deficiency.

The findings suggest an increased risk of vitamin B12 deficiency associated with current dose and duration of metformin use despite adjustment for many potential confounders. This could have clinical implications in the future management strategies of DM using OHGA, especially when metformin if considered. The data underscore the need for monitoring subjects undergoing high-dose and/or prolonged-course metformin therapy.

Source: Arch Intern Med. 2006;166:1975-1979.

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