Vitamin B12 deficiency in patients with diabetes at a specialised diabetes clinic, Botswana

Efficacy of metformin on different adipocytokines in type 2 diabetes mellitus patients

Background

Type 2 diabetes mellitus is a major medical condition that constitutes a significant financial burden on most healthcare systems.

Objective

The current research aimed to evaluate the antidiabetic, anti-inflammatory, and antihyperlipidemic effects of 500 mg metformin twice daily for 6 months on various adipocytokines in type 2 diabetes mellitus patients.

Patients and methods

The participants in this study were divided into three groups: the control, the untreated diabetic, and the metformin-treated diabetic groups.

Results and conclusion

Metformin treatment significantly improved the poor oral glucose tolerance and the lowered serum levels of insulin and C-peptide with subsequent better homeostatic model assessment for insulin resistance and sensitivity and β-cell function results. Moreover, metformin treatment significantly decreased the elevated serum levels of glycosylated hemoglobin, high, low, and very low-density lipoproteins, adipokines (visfatin and resistin), and retinol-binding protein-4 expression, with a significant increase in total cholesterol and triglycerides. Metformin also reduced the proinflammatory cytokine expressions (interleukin-1β, interferon-γ, and tumor-necrosis factor-α). In conclusion, metformin can alleviate adipocytokines through anti-inflammatory effects, synergizing with its antidiabetic actions.

Emergence of Ectopic Adrenal Tissues-What are the Probable Mechanisms?

Ectopic adrenal tissue, defined as the formation of adrenal tissue in an abnormal anatomical location, is not a rare entity and may have clinical significance. Even though the mechanism for their emergence has not been fully understood, numerous cases of ectopic adrenal tissue have been reported, mostly in the vicinity of the original location of adrenal gland, such as in kidneys and gonads. In these cases, most authors attributed their emergence to a probable migration defect. However, this mechanism does not simply explain the ectopic tissues in remote locations, such as in the hypophysis or lungs. This review summarizes these reports, describing many different locations in which ectopic adrenal tissues were encountered, together with their suggested mechanisms.

Association between vitamin B12 level and clinical peripheral neuropathy in type 2 diabetic patients on metformin therapy

Background

Vitamin B12 malabsorption is one of the side effects of long-term metformin intake. Prolonged vitamin B12 deficiency can lead to irreversible nervous system damage. So, the current study aimed to determine the association between serum vitamin B12 level and clinical peripheral neuropathy among type 2 DM patients who are on metformin in comparison to those not taking it. It is a cross-sectional study that was conducted in Egypt and recruited 100 type 2 diabetic patients who were divided into 2 groups: metformin treated, and non-metformin treated (50 subjects per group). The collected data included personal history, medical history, dietetic history that included frequency of eating food rich in vitamin B12 and clinical peripheral neuropathy assessment by Toronto Clinical Scoring System (TCSS). Blood samples were collected for assessment of HbA1c and vitamin B12 level.

Results

Vitamin B12 deficiency was present in 4% of metformin group and 2% of non-metformin group. The mean value of vitamin B12 between metformin users (624.3 ± 364.1 pg/ml) and non-metformin users (991.0 ± 489.9 pg/ml) showed a high significant difference, p value < 0.001. There was a significant difference between study groups regarding HbA1c level (p value = 0.03). Peripheral neuropathy was significantly associated with HbA1c (p value = 0.04) and female gender (p value = 0.001).

Conclusions

Vitamin B12 level was lower in type 2 diabetic patients on metformin compared to those on other oral anti-diabetic drugs, but without significant deficiency. Peripheral neuropathy was significantly associated with poor glycemic control and female gender, but was not associated with vitamin B12 deficiency.