Diabetics Popping Metformin Pills Must Regularly Check Vitamin B12 Levels: UK Health Agency

Patients consuming the popular anti-diabetic pill metformin must check their vitamin B12 levels at regular intervals, the health agency of the United Kingdom has said in an advisory.

The warning holds relevance in the Indian context as well considering that the country is known as the diabetes capital of the world and accounts for 17% of the total number of diabetics globally.

As per the estimates released in 2021, there are close to 8 crore people with diabetes in India and the number is expected to increase to 13.5 crore by 2045.

Metformin is one of the most commonly used antidiabetic medicines across the globe including in India as it helps to control blood sugar in people with type 2 diabetes mellitus.

According to the UK’s advisory titled “Metformin and reduced vitamin B12 levels: new advice for monitoring patients at risk”, the decreased vitamin B12 levels, or vitamin B12 deficiency, is now considered to be a common side effect in patients on metformin treatment.

The deficiency, it said, is most common among patients who are receiving a higher dose or longer treatment duration or are those with existing risk factors.

The deficiency of vitamin B12 leads to anaemia as this micronutrient is needed to make red blood cells.

“We are therefore advising checking vitamin B12 serum levels in patients being treated with metformin who have symptoms suggestive of vitamin B12 deficiency,” said the advisory dated June 20. “We also advise that periodic monitoring for patients with risk factors for vitamin B12 deficiency should be considered.”

Metformin is an anti-diabetic medication that works by lowering glucose production in the liver, delaying the absorption of sugar (glucose) from the intestines, and increasing the body’s sensitivity to insulin.

According to Dr Anoop Mishra, executive chairman, Fortis C DOC, a chain that manages diabetes and other endocrinological diseases, “Metformin is an important drug and is given to about 80 per cent of diabetics.”

He said that while it has been known that metformin decreases B12 levels, it holds more relevance in the Indian context, especially because “Indian vegetarians are more likely to have B12 deficiency”.

“We supplement it for almost all patients,” he said while advising that all doctors should prescribe B12 testing among patients using metformin.

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