Metformin and Micronutrient Status in Type 2 Diabetes: Does Polypharmacy Involving Acid-Suppressing Medications Affect Vitamin B12 Levels?

Michael Wakeman, David T Archer Faculty of Health and Wellbeing, Sciences Complex, University of Sunderland, Sunderland SR1, UKCorrespondence: Michael WakemanFaculty of Health and Wellbeing, Sciences Complex, University of Sunderland, Sunderland SR1 3SD, UKTel +44 191 5153381Email mikepwakeman@gmail...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Wakeman M, Archer DT
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	h2 antagonists diabetes neuropathy folic acid magnesium microbiome Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/d2beae4ffe694e3e935c32f8640a73cd
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:d2beae4ffe694e3e935c32f8640a73cd
record_format	dspace
spelling	oai:doaj.org-article:d2beae4ffe694e3e935c32f8640a73cd2021-12-02T10:18:54ZMetformin and Micronutrient Status in Type 2 Diabetes: Does Polypharmacy Involving Acid-Suppressing Medications Affect Vitamin B12 Levels?1178-7007https://doaj.org/article/d2beae4ffe694e3e935c32f8640a73cd2020-06-01T00:00:00Zhttps://www.dovepress.com/metformin-and-micronutrient-status-in-type-2-diabetes-does-polypharmac-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007Michael Wakeman, David T Archer Faculty of Health and Wellbeing, Sciences Complex, University of Sunderland, Sunderland SR1, UKCorrespondence: Michael WakemanFaculty of Health and Wellbeing, Sciences Complex, University of Sunderland, Sunderland SR1 3SD, UKTel +44 191 5153381Email mikepwakeman@gmail.comAbstract: Metformin is the first-choice drug in uncomplicated type 2 diabetes (T2DM) and is effective in improving glycaemic control. It is the most widely prescribed oral antidiabetic medicine and has a good safety profile. However, there is an abundance of evidence that metformin use is associated with decreased Vitamin B12 status, though the clinical implications of this in terms of increased risk of diabetic peripheral neuropathy are debated. There is growing evidence that other B vitamins, vitamin D and magnesium may also be impacted by metformin use in addition to alterations to the composition of the microbiome, depending on the dose and duration of therapy. Patients using metformin for prolonged periods may, therefore, need initial screening with intermittent follow-up, particularly since vitamin B12 deficiency has similar symptoms to diabetic neuropathy which itself affects 40– 50% of patients with T2DM at some stage. Among patients with T2DM, 40% are reported to experience symptomatic gastroesophageal reflux disease (GORD), of whom 70% use oral antidiabetic medications. The most common medications used to treat GORD are proton pump inhibitors (PPIs) and antagonists of histamine selective H2 receptors (H2RAs), both of which independently affect vitamin B12 and magnesium status. Research indicates that co-prescribing metformin with either PPIs or H2RAs can have further deleterious effects on vitamin B12 status. Vitamin B12 deficiency related to metformin and polypharmacy is likely to contribute to the symptoms of diabetic neuropathy which may frequently be under-recognised. This review explores current knowledge surrounding these issues and suggests treatment strategies such as supplementation.Keywords: H2 antagonists, diabetes, neuropathy, folic acid, magnesium, microbiomeWakeman MArcher DTDove Medical Pressarticleh2 antagonistsdiabetesneuropathyfolic acidmagnesiummicrobiomeSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 13, Pp 2093-2108 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	h2 antagonists diabetes neuropathy folic acid magnesium microbiome Specialties of internal medicine RC581-951
spellingShingle	h2 antagonists diabetes neuropathy folic acid magnesium microbiome Specialties of internal medicine RC581-951 Wakeman M Archer DT Metformin and Micronutrient Status in Type 2 Diabetes: Does Polypharmacy Involving Acid-Suppressing Medications Affect Vitamin B12 Levels?
description	Michael Wakeman, David T Archer Faculty of Health and Wellbeing, Sciences Complex, University of Sunderland, Sunderland SR1, UKCorrespondence: Michael WakemanFaculty of Health and Wellbeing, Sciences Complex, University of Sunderland, Sunderland SR1 3SD, UKTel +44 191 5153381Email mikepwakeman@gmail.comAbstract: Metformin is the first-choice drug in uncomplicated type 2 diabetes (T2DM) and is effective in improving glycaemic control. It is the most widely prescribed oral antidiabetic medicine and has a good safety profile. However, there is an abundance of evidence that metformin use is associated with decreased Vitamin B12 status, though the clinical implications of this in terms of increased risk of diabetic peripheral neuropathy are debated. There is growing evidence that other B vitamins, vitamin D and magnesium may also be impacted by metformin use in addition to alterations to the composition of the microbiome, depending on the dose and duration of therapy. Patients using metformin for prolonged periods may, therefore, need initial screening with intermittent follow-up, particularly since vitamin B12 deficiency has similar symptoms to diabetic neuropathy which itself affects 40– 50% of patients with T2DM at some stage. Among patients with T2DM, 40% are reported to experience symptomatic gastroesophageal reflux disease (GORD), of whom 70% use oral antidiabetic medications. The most common medications used to treat GORD are proton pump inhibitors (PPIs) and antagonists of histamine selective H2 receptors (H2RAs), both of which independently affect vitamin B12 and magnesium status. Research indicates that co-prescribing metformin with either PPIs or H2RAs can have further deleterious effects on vitamin B12 status. Vitamin B12 deficiency related to metformin and polypharmacy is likely to contribute to the symptoms of diabetic neuropathy which may frequently be under-recognised. This review explores current knowledge surrounding these issues and suggests treatment strategies such as supplementation.Keywords: H2 antagonists, diabetes, neuropathy, folic acid, magnesium, microbiome
format	article
author	Wakeman M Archer DT
author_facet	Wakeman M Archer DT
author_sort	Wakeman M
title	Metformin and Micronutrient Status in Type 2 Diabetes: Does Polypharmacy Involving Acid-Suppressing Medications Affect Vitamin B12 Levels?
title_short	Metformin and Micronutrient Status in Type 2 Diabetes: Does Polypharmacy Involving Acid-Suppressing Medications Affect Vitamin B12 Levels?
title_full	Metformin and Micronutrient Status in Type 2 Diabetes: Does Polypharmacy Involving Acid-Suppressing Medications Affect Vitamin B12 Levels?
title_fullStr	Metformin and Micronutrient Status in Type 2 Diabetes: Does Polypharmacy Involving Acid-Suppressing Medications Affect Vitamin B12 Levels?
title_full_unstemmed	Metformin and Micronutrient Status in Type 2 Diabetes: Does Polypharmacy Involving Acid-Suppressing Medications Affect Vitamin B12 Levels?
title_sort	metformin and micronutrient status in type 2 diabetes: does polypharmacy involving acid-suppressing medications affect vitamin b12 levels?
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/d2beae4ffe694e3e935c32f8640a73cd
work_keys_str_mv	AT wakemanm metforminandmicronutrientstatusintype2diabetesdoespolypharmacyinvolvingacidsuppressingmedicationsaffectvitaminb12levels AT archerdt metforminandmicronutrientstatusintype2diabetesdoespolypharmacyinvolvingacidsuppressingmedicationsaffectvitaminb12levels
_version_	1718397438014783488

Metformin and Micronutrient Status in Type 2 Diabetes: Does Polypharmacy Involving Acid-Suppressing Medications Affect Vitamin B12 Levels?

Ejemplares similares