Comment on: Association of B12 deficiency and clinical neuropathy with metformin use in type 2 diabetes patients
Abstract
Sir, With reference to the aricle on ‘Association of B12 deficiency and clinical neuropathy with metformin use in type 2 diabetes patients, we would like to put forth our views.[1] The article by itself has no new message. Several studies have examined this association and the mechanisms involved. In addition, the design used by the authors may not be sufficient to prove a cause-effect relationship. Exhaustion of vitamin B12 stores usually occurs after 12 - 15 years of absolute vitamin B12 deficiency. Hence, the duration of therapy with metformin is an important parameter to be considered. In addition, the authors have not compared the duration of diabetes among those taking metformin versus those not taking metformin, although they mention that data regarding the duration of diabetes had been collected. The duration of disease is thus a major confounding factor, as it increases the chances of peripheral neuropathy, which by itself is a complication of the disease. Hence, two groups must be comparable with regard to duration of disease too. Many diabetic patients are also likely to receive vitamin supplementation, which has not been addressed. Absorption of the vitamin B12 -intrinsic factor complex is calcium-dependent and metformin interferes with this absorption. In support of this hypothesis, there is evidence that dietary calcium supplementation reverses metformin-induced vitaminB12 malabsorption.[2] Hence, patients taking calcium supplementation also need to have been…
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