Assessment of the knowledge and practice of Jordanian family medicine practitioners regarding vitamin B12 screening for type 2 diabetes mellitus patients on metformin

Main Article Content

Maysaa Waddah Alwadi https://orcid.org/0000-0002-9399-2074
Rawan Badaineh https://orcid.org/0000-0003-0628-086X
Tareq Alwedyan https://orcid.org/0009-0008-1159-4269
Esraa Gogazeh https://orcid.org/0000-0002-2879-5162
Ola A. Badir https://orcid.org/0000-0002-2239-3058

Keywords

Type 2 Diabetes Mellitus, Metformin, Vitamin B12 deficiency, Family Physicians

Abstract

Background: Metformin is one of the most important treatments for type 2 diabetes mellitus (T2DM) patients. Mostly metformin has a safe profile but in some cases, it may cause some serious long-term hematological and neurological side effects mainly due to vitamin B12 deficiency. It is proven that there is a strong association between B12 deficiency and hematological and neurological manifestations, especially for T2DM patients on metformin. Hence, the American Diabetic Association (ADA) recommends vitamin B12 screening for those on metformin for a long duration. Objectives: To evaluate the knowledge and practice of family physicians among diabetic patients on metformin, and to evaluate the factors that enhance and prevent vitamin B12 screening. Method: A validated questionnaire was designed and distributed online for family medicine practitioners between the period of in June and September 2022. 147 family physicians participated in the study. A scoring system was used to calculate the knowledge, practice, and total scores. Results: The results reveal a high total knowledge score among participants about vitamin B12 manifestations and screening in T2DM patients. However, only half of the participants follow the ADA recommendations routinely (53.06)%. The total practice score is low as most participants (87.7%) answer only 9 of 18 questions correctly. Moreover, the results show that those who follow ADA recommendations routinely have better knowledge and practice scores (p-value 0.00406). Conclusion: More awareness about ADA recommendations and the practice of vitamin B12 screening in T2DM patients who use metformin for family physicians is required, either by encouraging them to order B12 through workshops and continuous learning programs or by the availability of tools needed to test B12.

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References

1. Lam DW, LeRoith D. The worldwide diabetes epidemic. Curr Opin Endocrinol Diabetes Obes. 2012;19:93-6. https://doi. org/10.1097/MED.0b013e328350583a
2. IDF Diabetes Atlas 9th edition 2019. https://www.diabetesatlas.org/en/ (accessed Oct. 16, 2022).
3. Members. https://idf.org/our-network/regions-members/middle-east-and-north-africa/members/37-jordan.html (accessed Apr. 05, 2023).
4. Ajlouni K, Jaddou H, Batieha A. Diabetes and impaired glucose tolerance in Jordan: prevalence and associated risk factors. J Intern Med. 1998;244;317-323. https://doi.org/10.1046/j.1365-2796.1998.00369.x
5. Ajlouni K, Khader YS, Batieha A, et al. An increase in prevalence of diabetes mellitus in Jordan over 10 years. J. Diabetes Complications. 2008;22;317-324. https://doi.org/10.1016/j.jdiacomp.2007.01.004
6. Ajlouni K. Time trends in diabetes mellitus in Jordan between 1994 and 2017. Diabet Med. 2019;36:1176-1182. https://doi. org/10.1111/dme.13894
7. SF A. Characterizing the type 2 diabetes mellitus epidemic in Jordan up to 2050. Sci Rep. 2020;10. https://doi.org/10.1038/ s41598-020-77970-7
8. LE C, AL D, JE B. Association between metformin and vitamin B 12 deficiency in patients with type 2 diabetes: A systematic review and meta-analysis. Diabetes Metab. 2016;42;316-327 https://doi.org/10.1016/j.diabet.2016.03.008
9. SH K. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. J Korean Med Sci. 2014;29;965- 972. https://doi.org/10.3346/jkms.2014.29.7.965
10. Ahmed MA. Metformin and Vitamin B12 deficiency: Where do we stand? J Pharm Sci. 2016;19:382-398. https://doi. org/10.18433/J3PK7P
11. Alhaji JH. Vitamin B12 Deficiency in Patients with Diabetes on Metformin: Arab Countries. Nutrients. 2022;14. https://doi. org/10.3390/nu14102046
12. Nervo M. Vitamin B12 in metformin-treated diabetic patients: a cross-sectional study in Brazil. Rev Assoc Med Bras. 2011;57;46- 49. https://doi.org/10.1590/S0104-42302011000100015
13. Reinstatler L, Qi Y. P, Williamson R. S, et al. Association of biochemical B₁₂ deficiency with metformin therapy and vitamin B₁₂ supplements: the National Health and Nutrition Examination Survey, 1999-2006. Diabetes Care. 2012;35:327-333. https://doi. org/10.2337/dc11-1582
14. Calvo Romero JM, Ramiro Lozano JM. Vitamin B(12) in type 2 diabetic patients treated with metformin. Endocrinol Nutr. 2012;59:487-90. https://doi.org/10.1016/j.endonu.2012.06.005
15. EE M, IK S. Recommendations for diagnosis and management of metformin-induced vitamin B12 (Cbl) deficiency. Diabetes Res Clin Pract. 2012;97:359-67. https://doi.org/10.1016/j.diabres.2012.06.001
16. Kancherla V. Long-term Metformin Therapy and Monitoring for Vitamin B12 Deficiency Among Older Veterans. J Am Geriatr Soc. 2017;65:1061-1066. https://doi.org/10.1111/jgs.14761
17. Pratama S, Lauren BC, Wisnu W. The efficacy of vitamin B12 supplementation for treating vitamin B12 deficiency and peripheral neuropathy in metformin-treated type 2 diabetes mellitus patients: A systematic review. Diabetes Metab Syndr. 2022;16.
https://doi.org/10.1016/j.dsx.2022.102634
18. Association AD. Standards of Medical Care in Diabetes—2018 Abridged for Primary Care Providers. Clin. Diabetes. 2018;36;14- 37. https://doi.org/10.2337/cd17-0119
19. Katon W, Von Korff M, Lin E, et al. Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse. Gen. Hosp. Psychiatry. 2001;23:138-144. https://doi.org/10.1016/s0163-8343(01)00136-0
20. Alshammari A, Iqbal R, Baksh I. Vitamin B12 deficiency and the knowledge and practice of physicians regarding screening for vitamin B12 deficiency among type 2 diabetic patients on metformin in selected hospitals in Riyadh, Saudi Arabia. J Fam Med Prim Care. 2019;8:2306. https://doi.org/10.4103/jfmpc.jfmpc_416_19
21. Viollet B. Cellular and molecular mechanisms of metformin: an overview. Clin Sci. 2012;122:253-270. https://doi.org/10.1042/ CS20110386
22. Aroda VR. Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study. J Clin Endocrinol Metab. 2016;101:1754-1761 https://doi.org/10.1210/jc.2015-3754
23. Bell DSH. Metformin-induced vitamin B12 deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy in the patient with diabetes. Diabetes Obes Metab. 2022;24:1423-1428. https://doi.org/10.1111/dom.14734
24. Infante M, Leoni M, Caprio M, et al. Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind. World J Diabetes. 2021;12:916. https://doi.org/10.4239/wjd.v12.i7.916
25. Prevention or Delay of Type 2 Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44:S34-S39. https:// doi.org/10.2337/dc21-S003
26. Fogelman Y, Goldfracht M, Karkabi K. Managing Diabetes Mellitus: A Survey of Attitudes and Practices Among Family Physicians. J Community Health. 2015;40:1002-1007 https://doi.org/10.1007/s10900-015-0024-2
27. Fogelman Y. Vitamin B12 screening in metformin-treated diabetics in primary care: were elderly patients less likely to be tested? Aging Clin Exp Res. 2017;29:135-139. https://doi.org/10.1007/s40520-016-0546-1
28. Krishnan GD, Zakaria MH, Yahaya N. Prevalence of Vitamin B12 Deficiency and its Associated Factors among Patients with Type 2 Diabetes Mellitus on Metformin from a District in Malaysia. J ASEAN Fed Endocr Soc. 2020;35:163-168. https://doi. org/10.15605/jafes.035.02.03
29. Martin D, Thaker J, Shreve M, et al. Assessment of vitamin B12 deficiency and B12 screening trends for patients on metformin: a retrospective cohort case review. BMJ Nutr Prev Heal. 2021;4:30-35. https://doi.org/10.1136/bmjnph-2020-000193
30. Wee AKH, Sultana R. Determinants of vitamin B12 deficiency in patients with type -2 diabetes mellitus - A primary-care retrospective cohort study. BMC Prim Care. 2023;24:102. https://doi.org/10.1136/bmjnph-2020-000193