PMID- 37081390
OWN - NLM
STAT- MEDLINE
DCOM- 20230424
LR  - 20230512
IS  - 2731-4553 (Electronic)
IS  - 2731-4553 (Linking)
VI  - 24
IP  - 1
DP  - 2023 Apr 20
TI  - Determinants of vitamin B12 deficiency in patients with type-2 diabetes 
      mellitus - A primary-care retrospective cohort study.
PG  - 102
LID - 10.1186/s12875-023-02057-x [doi]
LID - 102
AB  - BACKGROUND: Like many developed nations, the prevalence of both older people and 
      type-2 diabetes mellitus (T2DM) in Singapore is rising. This demographic shift 
      predisposes the population to greater risks of both frailty and its complications 
      that can be further aggravated by vitamin B12 deficiency -a highly prevalent 
      associated variable that is potentially modifiable. Indeed, B12 deficiency 
      adversely impacts the neuro-cognitive, haematological, and even the immune 
      systems; jeopardizing our aspirations for successful aging. Despite this, many 
      patients with T2DM in primary care remain unscreened due to a lack of clear 
      guidelines for regular B12 screening. We therefore investigated the determinants 
      of B12 deficiency in community-dwelling patients with T2DM, with the aim of 
      profiling patients most in need of B12-deficiency screening. METHODS: B12 
      deficiency was evaluated using a retrospective cross-sectional cohort of 592 
      primary-care patients with T2DM, recruited from 2008 to 2011 from a Polyclinic in 
      Singapore. RESULTS: B12 deficiency (serum B12 < 150 pmol/L) was present in 164 
      (27.7%) patients and was associated with a higher "metformin daily dose" (OR = 
      2.79; 95% CI, 2.22-3.48, P < 0.001); "age >/= 80 years" (OR = 2.86; 95% CI, 
      1.31-6.25, P = 0.008); "vegetarianism" (OR = 21.61; 95% CI, 4.47-104.44, P < 
      0.001); and "folate deficiency" (OR = 2.04; 95% CI, 1.27-3.28, P = 0.003). 
      Conversely, "Prescribed B12 supplementation" was associated with a lower odds of 
      B12 deficiency (OR = 0.37; 95% CI: 0.22-0.61, P < 0.001). The area under the 
      receiver operating characteristic curve was 0.803 (95% CI: 0.765-0.842). 
      "Metformin daily dose" correlated interchangeably with "Metformin 1-year 
      cumulative dose" (r = 0.960; P < 0.01), and also associated linearly with 
      "duration of diabetes" (B = 0.113, P < 0.0001). Independent of the duration of 
      T2DM, 29.3% of the B12-deficient patients needed > 1 screening test before the 
      detection of B12 deficiency. CONCLUSIONS: Primary-care screening for B12 
      deficiency should be part of the annual laboratory review of patients with T2DM 
      regardless of the duration of T2DM -especially when they are prescribed 
      >/= 1.5 g/day of metformin; >/= 80 years old; vegetarian; and not prescribed B12 
      supplementation. Concurrent evaluation for associated folate (vitamin B9) 
      deficiency is essential when addressing T2DM-associated B12 deficiencies. Current 
      "Metformin daily dose" is an accurate proxy of both cumulative metformin exposure 
      and duration of T2DM.
CI  - (c) 2023. The Author(s).
FAU - Wee, Andrew Kien Han
AU  - Wee AKH
AUID- ORCID: 0000-0002-3680-1614
AD  - SingHealth Polyclinics, Marine Parade Polyclinic, Blk 80 Marine Parade Central, 
      #01-792, Singapore, 440080, Republic of Singapore. aweekh@singnet.com.sg.
AD  - SingHealth Duke-NUS Medical School. Family Medicine Academic Clinical Programme 
      ("FM ACP"), Office of Academic & Clinical Development, 8 College Road, Singapore, 
      169857, Republic of Singapore. aweekh@singnet.com.sg.
FAU - Sultana, Rehena
AU  - Sultana R
AUID- ORCID: 0000-0001-9347-5571
AD  - Duke-NUS Medical School, Centre for Quantitative Medicine, 8 College Road, 
      Singapore, 169857, Republic of Singapore.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20230420
PL  - England
TA  - BMC Prim Care
JT  - BMC primary care
JID - 9918300889006676
RN  - 0 (Hypoglycemic Agents)
RN  - P6YC3EG204 (Vitamin B 12)
RN  - 9100L32L2N (Metformin)
RN  - 935E97BOY8 (Folic Acid)
SB  - IM
MH  - Humans
MH  - Aged
MH  - Aged, 80 and over
MH  - Retrospective Studies
MH  - Hypoglycemic Agents/therapeutic use
MH  - Cross-Sectional Studies
MH  - Vitamin B 12/therapeutic use
MH  - *Diabetes Mellitus, Type 2/complications/drug therapy/epidemiology
MH  - *Vitamin B 12 Deficiency/diagnosis/epidemiology/complications
MH  - *Metformin/therapeutic use
MH  - Folic Acid
PMC - PMC10116480
OTO - NOTNLM
OT  - COVID-19
OT  - Elderly
OT  - Folate deficiency
OT  - Metformin
OT  - Vegetarianism
OT  - Vitamin B12 deficiency
COIS- The authors declare no competing interests.
EDAT- 2023/04/21 00:41
MHDA- 2023/04/24 06:42
PMCR- 2023/04/20
CRDT- 2023/04/20 23:34
PHST- 2022/11/16 00:00 [received]
PHST- 2023/04/11 00:00 [accepted]
PHST- 2023/04/24 06:42 [medline]
PHST- 2023/04/21 00:41 [pubmed]
PHST- 2023/04/20 23:34 [entrez]
PHST- 2023/04/20 00:00 [pmc-release]
AID - 10.1186/s12875-023-02057-x [pii]
AID - 2057 [pii]
AID - 10.1186/s12875-023-02057-x [doi]
PST - epublish
SO  - BMC Prim Care. 2023 Apr 20;24(1):102. doi: 10.1186/s12875-023-02057-x.