Effect of Glycemic Control (HbA1c) on Vitamin B12 Level in Patients with Type 2 Diabetes Mellitus in Babylon City/Iraq

Authors

  • Maha Qasim Abdul Zahra MBChB
  • Prof. Dr. Manal Kamal Rasheed Ph.D. (Clinical Biochemistry), Professor of Clinical Biochemistry, Department of Biochemistry, College of Medicine, Baghdad University

Keywords:

Diabetes mellitus, Glycemic control, HbA1c, Vitamin B12 level, Babylon, Iraq

Abstract

Background:
Vitamin B12 deficiency is a recognized in T2DM patients. Several studies suggest an association between glycemic control and B12 levels. Various studies have shown increased prevalence of vitamin B12 deficiency in patients with type 2 diabetes on Metformin therapy, an antihyperglycemic agent used as first-line treatment for prediabetes and diabetes, might reduce the absorption of vitamin B12 and significantly reduce serum vitamin B12 concentrations. 
Objectives:
To study effect of Glycemic control (HbA1c) on vitamin B12 level in patients with type 2 Diabetes mellitus treated with metformin therapy.
Subjects and method:
Analytical case control study was conducted from February to October 2024 at private clinic of Diabetes at Babylon city on a total of ninety subjects; thirty healthy controls Hb A1c less than 5.7%), thirty diabetic patients with good glycemic (Hb A1c less than 7%), and thirty diabetic patients with inadequate glycemic control (HbA1c more than 7%). The measurement of HbA1c by A1Care Analyzer, fasting blood sugar by spectrophotometer, vitamin B12 by Fully automated closed system chemiluminescent assay analyzer (MAGLUMI 800 Snibe).
Results:
Negative correlation between vitamin B12 and HbA1c (r=-0.64, p<0.001), negative correlation with metformin dose (r=-0.66, p<0.001) and negative correlation with metformin duration (r-0.74, p<0.001). Positive correlation between HbA1c and metformin dose (r 0.701 p<0.001) and metformin duration (r 0.78, p<0.001). Positive correlation between metformin dose and metformin duration (r 0.82, p <0.001).
Conclusion: In patients with type 2 diabetes mellitus who had been taking metformin; Incidence of vitamin B12 deficiency is high. Vitamin B12 deficiency is correlated closely with metformin dose and duration.Older age is a significant risk factor for vitamin B12 deficiency. Vitamin B12 deficiency is significantly related to inadequate glycemic control

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References

Gedebjerg A, Thomsen RW, Kjaergaard AD, Steffensen R, Nielsen JS, Rungby J, et al. Mannose-binding lectin and risk of infections in type 2 diabetes: A Danish cohort study. J Diabetes Complications. 2021;35(5):107873.

Lee KJ, Carlin JB. Multiple imputation for missing data: fully conditional specification versus multivariate normal imputation. Am J Epidemiol. 2010;171:624–32.

Sterne JA, White IR, Carlin JB. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. et al. 2009;338:b2393.

Hamdi RA, Rasheed MK. Insulin Resistance and Risk of Chronic Renal Impairment in Non and Diabetic Iraqi Adults. Karbala J Med. 2013;6.

Galicia-Garcia U, Benito-Vicente A, Jebari S, Larrea-Sebal A, Siddiqi H, Uribe KB, et al. Pathophysiology of Type 2 Diabetes Mellitus. Int J Mol Sci. 2020 Aug;21(17).

Farhan AR, Rasheed MK. Estimation of Preptin Serum level, Insulin Resistance and other biochemical parameters in Pre-diabetic and Newly Diagnosed Type 2 Diabetic Mellitus. HIV Nurs. 2023;23(2):196–201.

Chatterjee S, Khunti K, Davies MJ. Type 2 diabetes. Lancet. 2017;389(10085):2239–51.

Ong KL, Stafford LK, McLaughlin SA, Boyko EJ, Vollset SE, Smith AE, et al. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023;402(10397):203–34.

Mansour AA, Al-Maliky AA, Kasem B, Jabar A, Mosbeh KA. Prevalence of diagnosed and undiagnosed diabetes mellitus in adults aged 19 years and older in Basrah, Iraq. Diabetes, Metab Syndr Obes targets Ther. 2014;139–44.

Abusaib M, Ahmed M, Nwayyir HA, Alidrisi HA, Al-Abbood M, Al-Bayati A, et al. Iraqi Experts Consensus on the Management of Type 2 Diabetes/Prediabetes in Adults. Clin Med Insights Endocrinol Diabetes. 2020;13(7):1–11.

Adeyinka A, Kondamudi NP. Hyperosmolar Hyperglycemic Syndrome BT - StatPearls. In StatPearls Publishing; 2023.

Rosager E V, Heltø AL, Fox Maule CU, Friis-Hansen L, Petersen J, Nielsen FE, et al. Incidence and characteristics of the hyperosmolar hyperglycemic state: a Danish cohort study. Diabetes Care. 2024;47(2):272–9.

Al-Fakhar SA, Rasheed MK. The Role of anti-DNA Abs. in Chronic Renal Failure in Diabetes Mellitus Type I and Type II. Iraqi Postgrad Med J. 2014;13.

Saleh DM, Rasheed MK, Alwandi NK. A comparison with micro albuminuria indicates whether urine and serum kidney injury molecule-1 can predict the onset of early diabetic nephropathy (DN). Bionatura. 2023;8(3):46.

Vijan S. In the clinic: Type 2 diabetes. Ann Intern Med. 2010;152(5):ITC31-35.

English E, Lenters-Westra E. HbA1c method performance: the great success story of global standardization. Crit Rev Clin Lab Sci. 2018;55(6):408–19.

Gilstrap LG, Chernew ME, Nguyen CA, Alam S, Bai B, McWilliams JM, et al. Association between clinical practice group adherence to quality measures and adverse outcomes among adult patients with diabetes. JAMA Netw Open. 2019;2(8):e199139.

Wu TE, Su YW, Chen HS. Mean HbA1c and HbA1c variability are associated with differing diabetes-related complications in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2022;192:110069.

Heinemann L, Freckmann G. Quality of HbA1c Measurement in the Practice: The German Perspective. J Diabetes Sci Technol. 2015;9(3):687–95.

Pilla R, Palleti SK, Rayana R, Skss SR, Abdul Razzack A, Kalla S. Glycated Haemoglobin (HbA1c) Variations in Nondiabetics With Nutritional Anemia. Cureus. 2020;12(11):e11479.

Lacy ME, Wellenius GA, Sumner AE, Correa A, Carnethon MR, Liem RI, et al. Association of Sickle Cell Trait With Hemoglobin A1c in African Americans. JAMA. 2017;317(5):507–15.

Guo W, Zhou Q, Jia Y, Xu J. Increased Levels of Glycated Hemoglobin A1c and Iron Deficiency Anemia: A Review. Med Sci Monit. 2019;25:8371–8.

Hellman R. When are HbA1c values misleading? AACE Clin Case Reports. 2016;2:e377-379.

American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021 Jan;44(Suppl 1):S73-S84.

Allen LH. Vitamin B-12. Adv Nutr. 2012;3:54–5.

Stabler SP. Vitamin B12 BT - Present Knowledge in Nutrition. In: Marriott BP, Birt DF, Stallings VA, Yates AA, editors. 2020. p. 257–71.

Bailey RL, Carmel R, Green R, Pfeiffer CM, Cogswell ME, Osterloh JD, et al. Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12. Am J Clin Nutr. 2011 Aug;94(2):552–61.

Ebesunun MO, Adetunji KJ, Obajobi EO. Evaluation of essential fatty acids, folic acid and vitamin B12 in type 2 diabetes mellitus. New York Sci J. 2012;5:56–64.

Al-Maskari MY, Waly MI, Ali A, Al-Shuaibi YS, Ouhtit A. Folate and vitamin B12 deficiency and hyperhomocysteinemia promote oxidative stress in adult type 2 diabetes. Nutrition. 2012;28(7–8):e23-26.

American Diabetes Association. Erratum. Microvascular Complications and Foot Care. Sec. 10. In Standards of Medical Care in Diabetes—2017. Diabetes Care 2017; 40 (Suppl. 1); S88–S98. Diabetes care. 2017 Jul; 40(7): 986.

Dominguez JC, Ng AR, Damian LF. A prospective, open label, 24-week trial of methylcobalamin in the treatment of diabetic polyneuropathy. Journal of diabetes mellitus. 2012 Nov 16;2(4):408-12.

Madhura TK, Kanyal L, Mujawar A. Effect of glycemic control on vitamin B12 status in type 2 diabetes mellitus. Indian J Basic Appl Med Res. 2019;1(9):7–17.

Weir CB, Jan A. BMI Classification Percentile And Cut Off Points. In: StatPearls. Treasure Island (FL): StatPearls Publishing; June 26, 2023. In StatPearls Publishing;

Mouchaileh N. Vitamin B12 deficiency in older people: a practical approach to recognition and management. J Pharm Pract Res. 2023;53(6):350–8.

Vincenti A, Bertuzzo L, Limitone A, D’Antona G, Cena H. Perspective: practical approach to preventing subclinical B12 deficiency in elderly population. Nutrients. 2021;13(6):1913.

Hasan NU, Makki MU, Abid I, Abid Butt MU. Association of vitamin B12 deficiency with intake of oral metformin in diabetic patients. J Ayub Med Coll Abbottabad. 2019;31(1):72–5.

Kwape L, Ocampo C, Oyekunle A, Mwita JC. Vitamin B12 deficiency in patients with diabetes at a specialised diabetes clinic, Botswana. J Endocrinol Metab Diabetes South Africa. 2021;26(3):101–5.

Sulaiman G, Ferrara N, Elbahi A, Elbaruni S. Vitamin B12 Deficiency in Type 2 Diabetes Patients Using Metformin. AlQalam J Med Appl Sci. 2023;160–5.

Abdelgawad FE, Bakri GM. Serum vitamin B12 and homocysteine levels in type 2 diabetic patients with and without metformin therapy. J Biomed Sci Eng. 2019;12(12):557.

Alvarez M, Sierra OR, Saavedra G, Moreno S. Vitamin B12 deficiency and diabetic neuropathy in patients taking metformin: a cross-sectional study. Endocr Connect. 2019;8(10):1324–9.

Mohammed AF, Al-Omer DK. Prevalence of Vitamin B12 Deficiency in Type 2 Diabetes Mellitus Patients on Metformin. Univ Thi-Qar J Med. 2023;26(2):32–41.

Soutelo J, Fritz C, Moldes S, Torzillo FB, Oliva Y, Carbajo N, et al. Relationship between dose of metformin and vitamin B12 deficiency. Curr Res Diabetes Obes J. 2020;12(5):117–24.

Swidan AK, Ahmed MA. Should we follow the guidelines on vitamin B12 deficiency and diabetes? A retrospective analysis of data from middle eastern population. Alexandria J Med. 2023;59(1):36–41.

Al Zoubi MS, Al Kreasha R, Aqel S, Saeed A, Al-Qudimat AR, Al-Zoubi RM. Vitamin B12 deficiency in diabetic patients treated with metformin: A narrative review. Irish J Med Sci. 2024;1–9.

Yang W, Cai X, Wu H, Ji L. Associations between metformin use and vitamin B12 levels, anemia, and neuropathy in patients with diabetes: a meta‐analysis. J Diabetes. 2019;11(9):729–43.

Harrington DJ. Methods for assessment of vitamin B12 BT - Laboratory assessment of vitamin status. In 2019. p. 265–99.

Alhaji JH. Vitamin B12 deficiency in patients with diabetes on metformin: Arab countries. Nutrients. 2022;14(10):2046.

Rao N, Godiyal P, Sati V, Bansal N, Jauhari R. Comparative Observational Study of Serum Vitamin B12 Levels in Newly Diagnosed Type 2 Diabetes Mellitus and Non-diabetic Patients. J Appl Pharm Sci Res. 2022;5(3):40–6.

Hamzah TM, Ali BM. Vitamin B12 Deficiency Among a Sample of Type 2 Diabetic Patients on Metformin in Erbil-City. AMJ (Advanced Med Journal). 2019;5(1):13–8.

Satapathy S, Bandyopadhyay D, Patro BK, Khan S, Naik S. Folic acid and vitamin B12 supplementation in subjects with type 2 diabetes mellitus: A multi-arm randomized controlled clinical trial. Complement Ther Med. 2020;53:102526.

Gülsen Ş, Deniz KE, Başak C, Alper G, Yeşil BS, Betül E. The effect of age and gender on HbA1c levels in adults without diabetes mellitus. J Med Biochem. 2023;42(4):714.

Published

2025-04-23

How to Cite

Maha Qasim Abdul Zahra, & Prof. Dr. Manal Kamal Rasheed. (2025). Effect of Glycemic Control (HbA1c) on Vitamin B12 Level in Patients with Type 2 Diabetes Mellitus in Babylon City/Iraq. Academic Journal of Clinicians, 7(2), 103–118. Retrieved from https://clinician.site/index.php/ajcs/article/view/166