Metformin, sold under the brand name Glucophage, among others, is the main first-line medication for the treatment of Type II diabetes, particularly in people who are overweight. It is also used in the treatment of polycystic ovary syndrome in women .It is sometimes used as an off-label adjunct to lessen the risk of metabolic syndrome in people who take antipsychotics. Metformin is not associated with weight gain and is taken by mouth.
Metformin is on the WHO List of Essential Medicines, and is the most widely used medication for diabetes taken by mouth.It is available as a generic medication. In 2021, it was the second most commonly prescribed medication in the United States of America , with more than 91 million prescriptions.
The American Diabetes Association and the American College of Physicians both recommend metformin as a first-line agent to treat Type II diabetes.It is as effective as repaglinide and more effective than all other oral drugs for Type II diabetes.
Side effects of Metformin:
Metformin commonly causes gastrointestinal symptoms such as diarrhea and flatulence,” explained a recent study published in the journal Diabetes, Obesity and Metabolism.
This is an important issue overlooked in most people.
Metformin is first line of drug for control or management of diabetes Type II.:It causes malabsorption of vitamin B12. Generally higher the dose of Metformin, greater is the risk of vitamin B12 deficiency .Diabetes it self is a risk factor for neurodegeneration in brain.This inturn increases the risk for memory loss , dementia and Alzheimer's disease.
Remady is not to discontinue with Metformin but take inexpensive vitamin B12 supplements.
Decreased vitamin B12 levels is a known consequence of long-term treatment with metformin. The mechanism is currently thought to be multifactorial, comprising altered intestinal motility, bacterial overgrowth, and reduced uptake of vitamin B12 within the small intestine
Low levels of vitamin B12 can cause serious and sometimes permanent neurological damage, as well as bone marrow production issues with subsequent anemia. This is why levels of this nutrient must be monitored in anyone taking metformin.
Professor Jill Crandall at National Institute of Medicine , Albert Einstein Medical college , Newyork discusses the findings of long term study on Metformin use and vitamin B12 deficiency under diabetes prevention program
outcome studies and shared the information that 5% of patients have vitamin B12 deficiency after 5 years of Metformin treatment and 9% of patients after long treatment of 9 years. Although the line of vitamin B12 treatment is uncleared ,She stated that higher doses of vitamin B12 may overcome the problem of malabsorption in Metformin treated diabetics. Although nowadays many alternative drugs are available to treat diabetes , Metformin having excellent safety profile, inexpensive , easily affordable and readily available drug , the health care taker should not stop prescribing it.
The mechanism of metformin causing vitamin B12 deficiency:
Metformin can cause vitamin B12 deficiency by reducing the absorption of the IF complex through the enteral cubilin receptor in the terminal ileum, which can either cause peripheral neuropathy, cardiac autonomic neuropathy, neuropsychiatric symptoms, or hematological disorders.
In B12 deficiency, homocysteine cannot be converted to methionine, and thus, methyl-THF (methyl Tetrahydrofolate) cannot be converted to THF. As a result, homocysteine levels accumulate, and pyrimidine bases cannot be formed, slowing down DNA synthesis and causing megaloblastic anemia.
All individuals age 14 or higher need 2.4 microgram B12 daily whether they take metformin or not. Women who are pregnant or nursing will need slightly more. Mandatory supplementation with B12 has now been proposed for those taking metformin.
Vitamin B12 level can be determined by blood test .
Values of less than 160 picogram/mL are a possible sign of a vitamin B12 deficiency
An abnormally high vitamin B12 status is anything over 900 picogram/mL . This result may suggest liver or kidney problems, diabetes, or certain forms of leukemia
Steps to prevent B12 deficiency on metformin includes plenty of foods rich in vitamin B12 in your diet, such as eggs, beef, salmon, chicken, and nutritional yeast; and/or taking supplemental B12.
Eating animal products, like meat, fish, eggs, and milk and dairy products
Looking for foods fortified with vitamin B12. These could be breakfast cereals and breads, nutritional yeast, or milk made from plants.
List of Fruits Rich in Vitamin B12
Apple,Banana,Blueberry,
Orange, Mango to get your dietary fix of vitamin B12. Each of such vitamin B12 fruit has numerous beneficial nutrients that contribute to eating a vitamin B12 nutrient-dense diet.
Vitamin B12 supplements don't interact with metformin, so they can safely be taken together. However, it's always a good idea to keep a current list of all your prescription and OTC medications. This helps your healthcare provider and pharmacist make sure there are no interactions to be concerned about.
B12 supplementation: A healthcare professional may recommend B12 supplements, which can be taken orally or administered through injections.
A patient taking metformin need B12 and folic acid monitored because the low levels of vitamin B12 can cause serious and sometimes permanent neurological damage, as well as bone marrow production issues with subsequent anemia. This is why levels of this nutrient must be monitored in anyone taking metformin.
Metformin may rarely cause a serious, life-threatening condition called lactic acidosis. Tell your doctor if you have kidney disease.
Taking metformin can cause vitamin B12 deficiency. Call your doctor or call 108 straight away if you: feel very tired. have muscle weakness,
Therapies include prophylactic calcium and vitamin B12 supplements, metformin withdrawal, replenishing vitamin B12 stores with intramuscular or oral vitamin B12.
Summary:
Vitamin B12 deficiency is a common side effect of Metformin medication . Proactively by monitoring and managing vitamin B12 levels is crucial while taking Metformin for your overall well-being .By maintaining open communication with your health care provider you can take control of your health and minimise the risk associated with long- term Metformin treatment.
Information compiled by Dr. Bhairavsinh Raol
