CORRELATION AND PREVALENCE OF MEGALOBLASTIC ANAEMIA IN TYPE 2 DIABETIC PATIENTS USING METFORMIN

Authors

  • Ghulam Farooq PIMS/PIMC Peshawar, Medical Ward,
  • Sidra Humayun Department of Pathology, Muhammad College of Medicine Peshawar, Pakistan
  • Muhammad Ishfaq Associate Professor of Medicine, Medicine C Ward, HMC Peshawar
  • Javaid Hassan Dr Javaid Hassan, AP Physiology, Department of Physiology, Muhammad College of Medicine, Peshawar
  • Raveed Khan Resident Trainee, Medical C Ward HMC, Peshawar
  • Hina Gul House Officer, Medical C Ward HMC, Peshawar

Keywords:

Diabetes Mellitus, Metformin, HbA1c, vitamin B12, megaloblastic anemia

Abstract

Background: Metformin is the most widely used drug in the management of type 2 diabetic patients but its use is associated with vitamin B12 deficiency induced megaloblastic anaemia. However few studies in Pakistan have assessed this risk. This study was conducted to determine correlation and prevalence of megaloblastic anaemia in type 2 diabetics treated with metformin. Methods: This cross-sectional study was carried out in the Department of Medicine, Hayatabad Medical Complex, Peshawar from Dec 2021 to Nov 2022. A total of 156 type 2 diabetic patients who were taking metformin at least for the last 2 years, were included in the study. All these patients were evaluated for anaemia, raised Mean Corpuscular Volume (MCV) and vitamin B12 levels. Results: Out of 156 patients who participated in the study, 94 (60.25%) were male and 62 (39.75%) were female with a mean age of 57.56±8.5 years. Mean duration of diabetes was 7.37±3.61 years, whereas mean duration of metformin use was 5.85±2.9 years. Vitamin B12 deficiency was identified in 51 (32.69%) patients. These B12 deficient patients demonstrated a mean Hb of 9.8±1.4 g/dL. Hyper-segmented neutrophils and raised MCV (mean MCV 98.7±6.90 fl was also identified in them. There was a no correlation between serum B12 levels and dose and duration of metformin. Conclusion: Long term metformin use is significantly associated with B12 deficiency associated megaloblastic anaemia.

Diabetes Mellitus, Metformin, HbA1C, Vitamin B12, Megaloblastic Anaemia

Pak J Physiol 2023;19(3):23–6

Downloads

Download data is not yet available.

References

Tinajero MG, Malik VS. An update on the epidemiology of type 2 diabetes: a global perspective. Endocrinol Metab Clin 2021;50(3):337–55.

Reed J, Bain S, Kanamarlapudi V. A review of current trends with Type 2 Diabetes epidemiology, aetiology, pathogenesis, treatments and future perspectives. Diabetes Metab Syndr Obes 2021;14:3567–602.

Kirpichnikov D, McFarlane SI, Sowers JR. Metformin: an update. Ann Intern Med 2002;137(1):25–33.

Zhang K, Yang W, Dai H, Deng Z. Cardiovascular risk following metformin treatment in patients with type 2 diabetes mellitus: Results from meta-analysis. Diabetes Res Clin Pract 2020;160:10800.

Aroda VR, Edelstein SL, Goldberg RB, Knowler WC, Marcovina SM, Orchard TJ, et al. Long-term metformin use and vitamin B12 deficiency in the diabetes prevention program outcomes study. J Clin Endocrinol Metab 2016;101(4):1754–61.

Owen MD, Baker BC, Scott EM, Forbes K. Interaction between metformin, folate and vitamin B12 and the potential impact on fetal growth and long-term metabolic health in diabetic pregnancies. Int J Mol Sci 2021;22(11):5759.

Ma Y, Peng D, Liu C, Huang C, Luo J. Serum high concentrations of homocysteine and low levels of folic acid and vitamin B12 are significantly correlated with the categories of coronary artery diseases. BMC Cardiovasc Disord 2017;17:37.

Cho HS, Huang LK, Lee YT, Chan L, Hong CT. Suboptimal baseline serum vitamin B12 is associated with cognitive decline in people with Alzheimer’s disease undergoing cholinesterase inhibitor treatment. Front Neurol 2018;9:325.

Osman H, Alwasaidi TA, Al-Hebshi A, Almutairi N, Eltabbakh H. Vitamin B12 deficiency presenting with microangiopathic hemolytic anemia. Cureus 2021;13(1):e12600.

Owhin SO, Adaja TM, Fasipe OJ, Akhideno PE, Kalejaiye OO, Kehinde MO. Prevalence of vitamin B12 deficiency among metformin-treated type 2 diabetic patients in a tertiary institution, South-South Nigeria. SAGE Open Med 2019;7:2050312119853433.

Iftikhar R, Qadir A, Iqbal Z, Usman H. Prevalence of vitamin B12 deficiency in patients of type 2 diabetes mellitus on metformin: a case control study from Pakistan. Pan Afr Med J 2014;16:67.

Ko SH, Ko SH, Ahn YB, Song KH, Han KD, Park YM, et al. Association of vitamin B12 and metformin in type 2 diabetes. J Korean Med Sci 2014;29(7):965–72.

Infante M, Leoni M, Caprio M, Fabbri A. Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind. World J Diabetes 2021;12:916–31.

Bauman WA, Shaw S, Jayatilleke E, Spungen AM, Herbert V. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000;23(9):1227–31.

Koduri VL, Nori SNS, Aditya SRKK, Madaboina S, Sindhuja ABK, Swati S. Haematological parameters and vitamin B12 levels in type II diabetic patients on metformin —a prospective case control study. J Evid Based Med Healthc 2018;5(31):2317–23.

Kang D, Yun JS, Ko SH, Lim TS, Ahn YB, Park YM, et al. Higher prevalence of metformin-induced vitamin B12 deficiency in sulfonylurea combination compared with insulin combination in patients with type 2 diabetes: a cross-sectional study. PLoS One 2014;9(10):e109878.

Marar O, Senturk S, Agha A, Thompson C, Smith D. The prevalence of vitamin B12 deficiency in patients with type 2 diabetes mellitus on metformin. R Coll Surg Irel Stud Med J 2011;4(1):16–20.

Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore) 2019;98(46):e17918.

Downloads

Published

30-09-2023

How to Cite

1.
Farooq G, Humayun S, Ishfaq M, Hassan J, Khan R, Gul H. CORRELATION AND PREVALENCE OF MEGALOBLASTIC ANAEMIA IN TYPE 2 DIABETIC PATIENTS USING METFORMIN. Pak J Phsyiol [Internet]. 2023 Sep. 30 [cited 2024 Jun. 13];19(3):23-6. Available from: https://pjp.pps.org.pk/index.php/PJP/article/view/1565