SEARCHCOHORTendocrinology, family medicine

cohort·endocrinology, family medicine, internal medicine, micronutrients, vitamins·PMC10116480

Determinants of vitamin B12 deficiency in patients with type-2 diabetes mellitus — A primary-care retrospective cohort study

BMC Primary Care · 2 authors, 3 centres

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TL;DR

In a retrospective cross-sectional cohort of 592 primary-care patients with type-2 diabetes mellitus in Singapore, B12 deficiency (serum B12 < 150 pmol/L) was present in 27.7% of patients and was independently associated with higher metformin daily dose, age ≥ 80 years, vegetarianism, and folate deficiency.

Full summary

704 CHARS

B12 deficiency (serum B12 < 150 pmol/L) was found in 27.7% of patients. Multivariable logistic regression identified higher metformin daily dose (adjusted OR = 2.79), age ≥ 80 years (adjusted OR = 2.86), vegetarianism (adjusted OR = 21.61), and folate deficiency (adjusted OR = 2.04) as independent risk factors, while prescribed B12 supplementation was protective (adjusted OR = 0.37). The multivariable model had an AUROC of 0.803. Metformin daily dose was a strong proxy for both cumulative metformin exposure (r = 0.960) and duration of diabetes (B = 0.113). Nearly one-third (29.3%) of B12-deficient patients required more than one screening test before detection, irrespective of diabetes duration.

STUDY TYPE

cohort

SPECIALTY

endocrinology

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10116480

Determinants of vitamin B12 deficiency in patients with type-2 diabetes mellitus — A primary-care retrospective cohort study

BMC Primary Care

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ABSTRACT

Abstract 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. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-023-02057-x. Keywords: Metformin, Folate deficiency, Elderly, Vegetarianism, COVID-19, Vitamin B12 deficiency

CITATION EXPORT

Andrew Kien Han Wee, Rehena Sultana. Determinants of vitamin B12 deficiency in patients with type-2 diabetes mellitus — A primary-care retrospective cohort study. BMC Primary Care. (2023). https://doi.org/10.1186/s12875-023-02057-x

AUTHORS

2 · 3 CENTRES

Andrew Kien Han Wee, Rehena Sultana

1SingHealth Polyclinics, Marine Parade Polyclinic, Blk 80 Marine Parade Central, #01-792, Singapore, 440080 Republic of Singapore
2SingHealth Duke-NUS Medical School. Family Medicine Academic Clinical Programme (“FM ACP”), Office of Academic & Clinical Development, 8 College Road, Singapore, 169857 Republic of Singapore
3Duke-NUS Medical School, Centre for Quantitative Medicine, 8 College Road, Singapore, 169857 Republic of Singapore