Patients taking the popular anti-diabetic pill metformin should check their vitamin B12 levels regularly, the UK health service has said in an advisory.
The warning is also relevant in the Indian context, as the country is known as the diabetes capital of the world and accounts for 17% of the total number of diabetics worldwide.
According to the estimates released in 2021, there are nearly 8 crore people with diabetes in India and the number is expected to increase to 13.5 crore by 2045.
Metformin is one of the most widely used anti-diabetic drugs around the world, including in India, as it helps control blood sugar levels in people with type 2 diabetes mellitus.
According to the UK advisory entitled “Metformin and Reduced Vitamin B12 Levels: New Advice for Monitoring Patients at Risk”, decreased vitamin B12, or vitamin B12 deficiency, is now considered a common side effect in patients treated with metformin .
The deficiency is most common in patients receiving a higher dose or longer duration of treatment or in patients with pre-existing risk factors.
The deficiency of vitamin B12 leads to anemia because this micronutrient is needed to make red blood cells.
“We therefore recommend monitoring serum vitamin B12 levels in patients treated with metformin who have symptoms suggestive of vitamin B12 deficiency,” said the June 20 advisory. “We also recommend that periodic monitoring of patients with risk factors for vitamin B12 deficiency should be considered.”
Metformin is a diabetes medicine that works by lowering glucose production in the liver, slowing the absorption of sugar (glucose) from the gut and increasing the body’s sensitivity to insulin.
According to Dr. Anoop Mishra, executive chairman of Fortis C DOC, a chain that manages diabetes and other endocrinological diseases, “Metformin is an important drug and is given to about 80 percent of diabetics.”
He said that while metformin is known to lower B12 levels, it is more relevant in the Indian context, especially since “Indian vegetarians are more likely to be B12 deficient.”
“We supplement it for almost all patients,” he said, advising that all doctors should prescribe B12 testing in patients taking metformin.
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