Assessment of vitamin B 12 deficiency and B 12 screening trends for patients on metformin: a retrospective cohort case review.

Autor: Martin D; Family Medicine, Henry Ford Hospital, Detroit, Michigan, USA., Thaker J; Family Medicine, Henry Ford Hospital, Detroit, Michigan, USA., Shreve M; Family Medicine, Henry Ford Hospital, Detroit, Michigan, USA., Lamerato L; Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA., Budzynska K; Family Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
Jazyk: angličtina
Zdroj: BMJ nutrition, prevention & health [BMJ Nutr Prev Health] 2021 Jan 04; Vol. 4 (1), pp. 30-35. Date of Electronic Publication: 2021 Jan 04 (Print Publication: 2021).
DOI: 10.1136/bmjnph-2020-000193
Abstrakt: Objectives: Our study investigated the use of vitamin B 12 testing in a large cohort of patients on metformin and assesses appropriateness and benefits of screening recommendations for vitamin B 12 deficiency.
Design: This retrospective cohort study included insured adult patients who had more than 1 year of metformin use between 1 January 2010 and 1 October 2016 and who filled at least two consecutive prescriptions of metformin to establish compliance. The comparison group was not exposed to metformin. Primary outcome was incidence of B 12 deficiency diagnosed in patients on metformin. Secondary outcome was occurrence of B 12 testing in the patient population on metformin. Records dated through 31 December 2018 were analysed.
Setting: Large hospital system consisting of inpatient and outpatient data base.
Participants: A diverse, adult, insured population of patients who had more than 1 year of metformin use between 1 January 2010 and 1 October 2016 and who filled at least two consecutive prescriptions of metformin.
Results: Of 13 489 patients on metformin, 6051 (44.9%) were tested for vitamin B 12 deficiency, of which 202 (3.3%) tested positive (vs 2.2% of comparisons). Average time to test was 990 days. Average time to test positive for deficiency was 1926 days. Factors associated with testing were linked to sex (female, 47.8%), older age (62.79% in patients over 80 years old), race (48.98% white) and causes of malabsorption (7.11%). Multivariable logistic regression showed older age as the only factor associated with vitamin B 12 deficiency, whereas African-American ethnicity approached significance as a protective factor.
Conclusions: Based on our study's findings of vitamin B 12 deficiency in patients on metformin who are greater than 65 years old and have been using it for over 5 years, we recommend that physicians consider screening in these populations.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze: MEDLINE
Externí odkaz: