Journal
SOUTHERN MEDICAL JOURNAL
Volume 103, Issue 3, Pages 265-267Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/SMJ.0b013e3181ce0e4d
Keywords
diabetes; malabsorption; metformin; neuropathy; vitamin B12 deficiency
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Chronic metformin use results in vitamin B12 deficiency in 30% of patients. Exhaustion of vitamin B12 stores usually occurs after twelve to fifteen years of absolute vitamin B12 deficiency. Metformin has been available in the United States for approximately fifteen years. Vitamin B12 deficiency, which may present without anemia and as a peripheral neuropathy, is often misdiagnosed as diabetic neuropathy, although the clinical findings are usually different. Failure to diagnose the cause of the neuropathy will result in progression of central and/or peripheral neuronal damage which can be arrested but not reversed with vitamin B12 replacement. To my knowledge, this is the first report of metformin-induced vitamin B12 deficiency causing neuropathy.
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