Vitamin B12 Deficiency in Type 2 Diabetic Subjects on Metformin Vs Metformin with Proton Pump Inhibitors in Tertiary Care Hospital, Mysore

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Abstract (English)

Introduction: Diabetes is a common co morbidity which is rising in prevalence in the modern era. Metformin is the foundation of treatment of type 2 DM. Most of the current international guidelines including American Diabetes Association state that Metformin should be the first line oral therapy prescribed. Proton Pump Inhibitors are also commonly used in patients with type 2 diabetes on Metformin, considering the gastrointestinal side effects of Metformin. This study is focusing on looking at the prevalence of VIT B12 deficiency in diabetics on Metformin VS Metformin with PPI. Methods: This study was conducted on 74 diabetics on metformin and 74 diabetics on metformin with PPI meeting inclusion and exclusion criteria. Patients were subjected to VIT B12 levels estimation. The data collected are entered in excel sheet and analysed using descriptive statistics namely mean, standard deviation, percentage and depicted in the form of frequency tables, figures, and graphs. Results: In the present study, the mean age in metformin group was 58.05 ± 8.70 and mean age in Metformin + PPI was 55.9 ± 7.55 years. (p=0.02) Majority of the patients belonged to the age group of 51to 60 years in the present study. Assuming the normal range of Vit B12 as 200-835 pg/mL we observed no association of administration of metformin with PPI and vitamin B12 deficiency in the present study. Based on vitamin B12 levels. Out of 47 patients having vitamin B12 <200, 23 patients (31.1%) were in Group A and 24 patients (32.4%) were in Group B. Out of 101 patient shaving vitamin B12 >200, 51 patients (68.9%) were in Group A and 50 patients (67.6%) were in Group B. The distribution of the subjects based on vitamin B12 was statistically not significant. (p=0.86). Conclusion: Diabetes affects a significant number of the population, with a large number of them being on metformin, as a first line medicine unless contraindicated. A significant number of them are also on PPI in view of the gastrointestinal effect so metformin. Vitamin B12 deficiency is known to occur in patients on metformin, which was also seen in this study, but there is conflicting evidence to the role PPI in causing Vit B 12 deficiency. This study also did not find statistically significant Vit B 12 deficiency when metformin was combined with PPI. Further large scale studies are necessary in this regards.