Serum Vitamin B12 Level in Patients with Type 2 Diabetes Mellitus on Metformin Therapy and its Impact on Peripheral Nerve Conduction: A Prospective Study.

Mymensingh medical journal : MMJ Pub Date : 2025-07-01
S L Wakode, A Singhai, R Gour, A E Thakare, S M Hulke, R Bharshankar, N S Wakode
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Abstract

Metformin is the primary treatment for newly diagnosed T2DM patients. However, Metformin may cause Vitamin B12 deficiency, which may either cause neuropathy or indirectly worsen hyperglycemia-induced neuropathy. Aims of the study was to record the effect of six months of regular metformin therapy on vitamin B12 level and to study the impact of Vitamin 12 on peripheral nerve conduction in response to 6 months of metformin therapy. This was a longitudinal study done in the Department of Physiology in collaboration with the Medicine Department of AIIMS, Bhopal, on 52 newly diagnosed cases of diabetes mellitus. A nerve conduction study was done at the start and at the end of six months using the Nihon Kohden Neuropack X1 Machine. Serum B12, homocysteine (HC), Methyl Malonic acid (MMA), RBS and HbA1c were estimated at the start and at the end of six months. The study involved 52 participants in the range of 38.8-49.0 years (Median- 45 years). Six months of metformin therapy significantly affected Vitamin B12 (decrease), serum HC (increase) and serum MMA levels (increase) (p<0.001). A significant decrease in amplitude and nerve conduction velocity was observed in the motor and sensory nerve conduction study. Significant correlations were seen between Vitamin B12 levels and a number of nerves affected, Serum MMA and Serum HC levels. Six months of metformin therapy had a significant effect on decreasing the level of vitamin B12. No new patient developed neuropathy; however significant decrease in amplitude in motor as well as sensory nerve conduction study was observed which may be due to significant decrement in B12 level. However, further studies are recommended in diabetic patients with large sample sizes and varied durations.

二甲双胍治疗2型糖尿病患者血清维生素B12水平及其对周围神经传导的影响:一项前瞻性研究
二甲双胍是新诊断T2DM患者的主要治疗方法。然而,二甲双胍可能导致维生素B12缺乏,这可能导致神经病变或间接加重高血糖诱导的神经病变。该研究的目的是记录六个月常规二甲双胍治疗对维生素B12水平的影响,并研究维生素12对周围神经传导的影响。这是一项纵向研究,由博帕尔AIIMS医学部与生理学系合作完成,研究对象是52例新诊断的糖尿病患者。在六个月的开始和结束时,使用Nihon Kohden Neuropack X1机器进行神经传导研究。在6个月开始和结束时测定血清B12、同型半胱氨酸(HC)、甲基丙二酸(MMA)、RBS和HbA1c。该研究涉及52名参与者,年龄在38.8-49.0岁之间(中位数- 45岁)。六个月的二甲双胍治疗显著影响维生素B12(降低)、血清HC(增加)和血清MMA水平(增加)(p
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