Journal
DIABETES RESEARCH AND CLINICAL PRACTICE
Volume 97, Issue 3, Pages 359-367Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.diabres.2012.06.001
Keywords
Cobalamin; Deficiency; Folate; Homocysteine; Metformin; MMA; Vitamin B12
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Metformin treatment is a known pharmacological cause of vitamin B12 (Cbl) deficiency with controversial responsible mechanisms. A possible diagnosis of this deficiency is based mainly on the combination of patient's medical history (usually long-term metformin use), clinical examination (possible neuropsychiatric symptoms and signs), laboratory studies which confirm a Cbl deficiency (haematological abnormalities, low serum Cbl levels, elevated serum total homocysteine and methylmalonic acid levels), and exclusion other causes of Cbl deficiency (as pernicious anaemia, food-cobalamin malabsorption syndrome, other drugs, etc.). In our review, recommendations for diagnosis and management of metformin-induced Cbl deficiency (MICD) in diabetic patients based on medical bibliography are presented and discussed. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
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