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Friday, May 28, 2010

Common Diabetes Drug and Vitamin Deficiency

I'm a big fan of the tried and true when it comes to medications and procedures. After tens of thousands or even better, hundreds of thousands of people have run the gauntlet, I too, am much more willing to give things a try. Call me a coward, but I get a big lift from following the crowd in this regard. So if I had type 2 diabetes I would be okay with taking metformin (after trying weight loss and dietary changes, of course). But now a study in the current issue of the British Medical Journal raises a red flag about metformin use: it may cause vitamin B12 deficiency.

In this long term study of several hundred people who were given metformin or placebo three times a day for an average of 4.3 years, those who received metformin saw a reduction in their levels of vitamin B12 of about 19%. People taking metformin also experienced an increase in homocysteine levels, a marker of cardiovascular disease risk, assumed to be caused by the decrease in vitamin B12.

Yowl! So what's a responsible person with diabetes to do? Uncontrolled diabetes is a major risk factor for cardiovascular disease, and now one of the most trusted agents for managing the condition may also precipitate increased risk? And when the other drugs used to manage type 2 diabetes are considered, things look bleak indeed.

Steady, now. Although the effects of vitamin B12 deficiency at the low end may include fatigue, poor memory and depression and at the high end, irreversible damage to the brain and other parts of the nervous system, the authors of this study suggest that simply measuring blood levels of the vitamin is a simple and prudent step. Those who are found to be deficient can first try consuming foods rich in B12: meats, fish, and milk and milk products among them. If these don't correct the problem supplements may be the answer. But there's no compelling reason to avoid metformin use as long as there's awareness of this possibility. And that's good news.

Other topics in this week's podcast include drowning prevention in Pediatrics, the dangers of multifocal eyeglasses in the elderly in BMJ, and sugar sweetened beverages and blood pressure in Circulation. Watch our YouTube, and until next week, y'all live well.

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