Vitamin B₁₂ deficiency is present in 22% of patients with Type 2 diabetes, researchers report.

Vitamin B₁₂ deficiency can lead to nerve symptoms similar to that of diabetic peripheral neuropathy. However, although many patients with diabetes are at risk for vitamin B₁₂ deficiency as a natural consequence of aging and as a result of treatment with metformin, the prevalence of the condition in this population was previously unknown.

In a cross-sectional study, Matthew Pflipsen (Raymond W Bliss Army Health Center, Fort Huachuca, Arizona, USA) and co-workers measured vitamin B₁₂ levels in 203 outpatients with Type 2 diabetes at a large military primary care clinic.

Vitamin B₁₂ deficiency was defined as serum B₁₂ levels of less than 100 pg/ml, or serum B₁₂ levels of 100 to 350 pg/ml with levels of serum methylmalonic acid greater than 243 nmol/l or levels of homocysteine greater than 11.9 nmol/l.

“Elevated methylmalonic acid and homocysteine levels improve the diagnosis of tissue B₁₂ deficiency and may identify patients with deficiency at an early, reversible stage,” explain the authors.

One patient had a B₁₂ level less than 100 pg/ml, and 43 patients with intermediate B₁₂ levels had elevations of either methylmalonic acid or homocysteine, resulting in a total of 44 patients (22%) diagnosed with metabolic B₁₂ deficiency.

Patients using metformin had lower B₁₂ levels, but metformin use was not associated with overt B₁₂ deficiency. The majority of patients were taking metformin and approximately half were on a dose of at least 2 g per day at the time of enrolment.

Just over half the patients in the study were taking a daily multivitamin tablet. In multivariate analysis, multivitamin use seemed to protect patients from B₁₂ deficiency.

Other factors associated with increased risk for B₁₂ deficiency, such as advanced age and use of proton pump inhibitors, were not significantly associated with B₁₂ deficiency.

The authors suggest that physicians should consider the comorbid effects of vitamin B₁₂ deficiency in a population already predisposed to neuropathic complications.

“Further studies need to be undertaken to determine whether screening and subsequent treatment can prevent peripheral neuropathy from developing in patients with Type 2 diabetes before advocating for universal screening,” the researchers conclude in the Journal of the American Board of Family Medicine.

“Multivitamin should also be explored as a method for reducing the incidence of B₁₂ deficiency in the Type 2 diabetic population” they add.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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