| Sumario: | Background: Metformin is a widely popular drug to treat type 2 diabetes as it is efficacious, inexpensive and relatively well tolerated with minimal side effect profile. It is known that long term metformin use predisposes a person to develop Vitamin B12 deficiency, however guidelines to screen and treat are yet to be well established. Vitamin B12 deficiency is known to cause peripheral neuropathy and anemia. Methods: Ours is a prospective, observational, cross sectional study based in a hospital setting in a tertiary care center. Study participants were subjected to serum Vitamin B12 analysis and Michigan neuropathy screening instrument was used to screen for peripheral neuropathy. Results: We report statistically significant association between metformin use and development of Vitamin B12 deficiency. The average duration of metformin use that resulted in development of Vitamin B12 deficiency was 13.6 years. We also found statistically significant association of metformin use with development of peripheral neuropathy. Conclusion: Long term metformin leading to Vitamin B12 deficiency is common knowledge, however we need more targeted guidelines on when to screen and treat for B12 deficiency. Some subsets of the population such as elderly and vegetarians are more prone and hence we need to educate more physicians and patients on the same. Plain language summary: Metformin Induced Vitamin B12 deficiency Diabetes is a hugely prevalent disease resulting from a persistently elevated blood glucose level. It adverse effects on overall lifespan and lifestyle are well known. Long standing diabetes is so dangerous as it affects blood vessels of different calibers which eventually leads to injury of the organs it supplies. Diabetic peripheral neuropathy is a term used when there is injury to nerves supplying the limbs because of long standing and often uncontrolled diabetes. A similar neuropathy/nerve damage may result from other causes such as Vitamin B12 deficiency. A popular drug used to control blood sugars is Metformin. It is considered effective and relatively safe and cost effective, making it a popular choice to treat Type 2 diabetes. Metformin has been known to contribute towards Vitamin B12 deficiency in a small sub group of users when used for a long duration. In this prospective observational study our intent primarily was to explore this association. Results from our study show that there is a direct association between the dose and duration of metformin use with the development of Vitamin B12 deficiency. This would mean that a person on long term metformin is more likely to develop Vitamin B12 deficiency as an undesired effect. This is in line with other Indian and International studies which have showed similar results as ours. Although our study also showed an increased likelihood of neuropathy with metformin use, the results were not statistically significant to make an association. New guidelines have since been set forth by the American diabetic association to screen for Vitamin b12 deficiency among people with diabetes on metformin. As this is a easily preventable side effect, when screened and treated, it is important to create awareness among both physicians and people with diabetes regarding this association.
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