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Yazidi M, Kammoun E, Oueslati I, Chihaoui M. Metformin-Induced Vitamin B12 Deficiency in Patients with Type 2 Diabetes: A Narrative Review with a Practical Approach for Screening, Diagnosing, and Managing Vitamin B12 Deficiency. Korean J Fam Med 2024; 45:189-198. [PMID: 39054838 PMCID: PMC11273170 DOI: 10.4082/kjfm.24.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/27/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024] Open
Abstract
Metformin is the most widely used antihyperglycemic drug in patients with type 2 diabetes (T2D). Over the past 2 decades, several studies have highlighted a substantial increase in the risk of vitamin B12 deficiency in patients with T2D on metformin therapy. This can lead to several complications and induce or exacerbate peripheral neuropathy. Despite these data, there are no definite guidelines for screening, diagnosing, and treating vitamin B12 deficiency in patients with T2D on metformin therapy. Therefore, in this narrative review, we aimed to suggest a practical diagnostic and therapeutic strategy to address vitamin B12 deficiency in patients with T2D receiving metformin treatment. Clinical evidence supporting an increased risk of vitamin B12 deficiency in patients with T2D on metformin therapy and its risk factors and potential complications are also discussed.
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Affiliation(s)
- Meriem Yazidi
- Department of Endocrinology, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Elyes Kammoun
- Department of Endocrinology, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ibtissem Oueslati
- Department of Endocrinology, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Melika Chihaoui
- Department of Endocrinology, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Oner M, Chen MC, Cheng PT, Li YH, Cheng YC, Celik A, Soong SW, Hsu LW, Lin DY, Hossain Prince GMS, Dhar T, Cheng HC, Tang PC, Lin H. Impact of metformin on neocortical development during pregnancy: Involvement of ERK and p35/CDK5 pathways. CHEMOSPHERE 2024; 358:142124. [PMID: 38677614 DOI: 10.1016/j.chemosphere.2024.142124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 04/29/2024]
Abstract
Metformin, the most commonly prescribed drug for the treatment of diabetes, is increasingly used during pregnancy to address various disorders such as diabetes, obesity, preeclampsia, and metabolic diseases. However, its impact on neocortex development remains unclear. Here, we investigated the direct effects of metformin on neocortex development, focusing on ERK and p35/CDK5 regulation. Using a pregnant rat model, we found that metformin treatment during pregnancy induces small for gestational age (SGA) and reduces relative cortical thickness in embryos and neonates. Additionally, we discovered that metformin inhibits neural progenitor cell proliferation in the sub-ventricular zone (SVZ)/ventricular zone (VZ) of the developing neocortex, a process possibly mediated by ERK inactivation. Furthermore, metformin induces neuronal apoptosis in the SVZ/VZ area of the developing neocortex. Moreover, metformin retards neuronal migration, cortical lamination, and differentiation, potentially through p35/CDK5 inhibition in the developing neocortex. Remarkably, compensating for p35 through in utero electroporation partially rescues metformin-impaired neuronal migration and development. In summary, our study reveals that metformin disrupts neocortex development by inhibiting neuronal progenitor proliferation, neuronal migration, cortical layering, and cortical neuron maturation, likely via ERK and p35/CDK5 inhibition. Consequently, our findings advocate for caution in metformin usage during pregnancy, given its potential adverse effects on fetal brain development.
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Affiliation(s)
- Muhammet Oner
- Department of Life Sciences, National Chung Hsing University, Taichung, 40227, Taiwan
| | - Mei-Chih Chen
- Translational Cell Therapy Center, Department of Medical Research, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Pang-Ting Cheng
- Department of Life Sciences, National Chung Hsing University, Taichung, 40227, Taiwan
| | - Yu-Hsuan Li
- Translational Cell Therapy Center, Department of Medical Research, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Yu-Chiao Cheng
- Department of Life Sciences, National Chung Hsing University, Taichung, 40227, Taiwan
| | - Ayse Celik
- Department of Life Sciences, National Chung Hsing University, Taichung, 40227, Taiwan
| | - Shiuan-Woei Soong
- Department of Life Sciences, National Chung Hsing University, Taichung, 40227, Taiwan
| | - Li-Wen Hsu
- Department of Life Sciences, National Chung Hsing University, Taichung, 40227, Taiwan
| | - Din-You Lin
- Department of Life Sciences, National Chung Hsing University, Taichung, 40227, Taiwan
| | | | - Trayee Dhar
- Department of Life Sciences, National Chung Hsing University, Taichung, 40227, Taiwan
| | - Hsu-Chen Cheng
- Department of Life Sciences, National Chung Hsing University, Taichung, 40227, Taiwan
| | - Pin-Chi Tang
- Department of Animal Science, National Chung Hsing University, Taichung, 40227, Taiwan
| | - Ho Lin
- Department of Life Sciences, National Chung Hsing University, Taichung, 40227, Taiwan.
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Jiang Y, Zhang Z, Zhu Y, Chai Y, Xie H. Dose-response association between dietary folate and niacin intakes with diabetes among Chinese adults: a cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:31. [PMID: 37038237 PMCID: PMC10084685 DOI: 10.1186/s41043-023-00362-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/01/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND The aim of this study was to examine the relationship between dietary intake of folate and niacin and diabetes risk in Chinese adults. METHODS This is a cross-sectional study. Demographic and anthropometric data along with information on dietary intake of vitamins were collected, and eligible participants were recruited to complete the questionnaire. A binary logistic regression analysis was conducted to examine the association between dietary intake of vitamins and diabetes risk, with adjustment for potential confounders. Non-linear dose-response relationships between dietary intake of folate and niacin and diabetes risk were also evaluated using adjusted restricted cubic splines. RESULTS Of the 3106 eligible participants, 15.9% had diabetes. Median folate was significantly higher in diabetic patients than in controls (32.030 vs. 27.600 gμ), while median niacin was significantly lower (7.000 vs. 7.900 mg). After controlling for potential confounders, binary logistic regression analysis showed that each unit increase in folate intake was associated with a 1.002-fold increase in the risk of developing diabetes (odds ratio (OR) = 1.002; 95% confidence interval (CI) 1.000-1.004; P = 0.022), while each unit increase in niacin intake was associated with a 3.5% reduction in diabetes risk (OR = 0.965; 95% CI 0.944-0.986; P = 0.001). The plots of restricted cubic splines presented an atypical inverted U-shaped association between dietary intake of folate and diabetes risk. CONCLUSIONS Diabetic patients had a low intake of vitamins, especially the B vitamins. Dietary intake of folate and niacin tended to be independently associated with the risk of diabetes. Nevertheless, this study is observational and a large-scale randomized controlled trial is yet to be conducted, which will add to the evidence of the study results.
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Affiliation(s)
- Yuhong Jiang
- Department of Epidemiology and Health Statistics, School of Public Health, Bengbu Medical College, Bengbu, China
| | - Zhiwen Zhang
- School of Public Health, Bengbu Medical College, Bengbu, China
| | - Yi Zhu
- School of Public Health, Bengbu Medical College, Bengbu, China
| | - Yongfei Chai
- School of Public Health, Bengbu Medical College, Bengbu, China
| | - Hong Xie
- Department of Nutrition and Food Hygiene School of Public Health, Bengbu Medical College, Bengbu, China.
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Wei J, Wei Y, Huang M, Wang P, Jia S. Is metformin a possible treatment for diabetic neuropathy? J Diabetes 2022; 14:658-669. [PMID: 36117320 PMCID: PMC9574743 DOI: 10.1111/1753-0407.13310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/29/2022] [Accepted: 08/16/2022] [Indexed: 12/04/2022] Open
Abstract
Metformin is a hypoglycemic drug widely used in the treatment of type 2 diabetes. It has been proven to have analgesic and neuroprotective effects. Metformin can reverse pain in rodents, such as diabetic neuropathic pain, neuropathic pain caused by chemotherapy drugs, inflammatory pain and pain caused by surgical incision. In clinical use, however, metformin is associated with reduced plasma vitamin B12 levels, which can further neuropathy. In rodent diabetes models, metformin plays a neuroprotective and analgesic role by activating adenosine monophosphate-activated protein kinase, clearing methylgloxal, reducing insulin resistance, and neuroinflammation. This paper also summarized the neurological adverse reactions of metformin in diabetic patients. In addition, whether metformin has sexual dimorphism needs further study.
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Affiliation(s)
- Juechun Wei
- The Second Medical CollegeBinzhou Medical UniversityYantaiChina
| | - Yanling Wei
- Qingdao Dongheng Zhiyuan Automobile Service Co. LTDQingdaoChina
| | - Meiyan Huang
- The Second Medical CollegeBinzhou Medical UniversityYantaiChina
| | - Peng Wang
- The Second Medical CollegeBinzhou Medical UniversityYantaiChina
| | - Shushan Jia
- Yantai Affiliated Hospital of Binzhou Medical UniversityYantaiChina
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Taş Ö, Kontbay T, Dogan O, Kose E, Berberoglu M, Siklar Z, Tumer L, Eminoglu FT. Does Metformin Treatment in Pediatric Population Cause Vitamin B12 Deficiency? KLINISCHE PADIATRIE 2022; 234:221-227. [PMID: 35114702 DOI: 10.1055/a-1702-2614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND/AIM There have been no studies to date examining the effect of metformin treatment on vitamin B12 status in children and adolescents. In this prospective study, the effects of metformin on blood vitamin B12, serum methylmalonic acid (MMA), homocysteine and holo-transcobalamin-II (holo-TC-II) levels were assessed in pediatric age group. MATERIALS AND METHODS This prospective study was conducted at the Pediatric Endocrinology and Adolescent Department between January 2017 and March 2019. Metabolic syndrome and polycystic ovary syndrome diagnosed patients with insulin resistance and/or impaired glucose tolerance, patients with type 2 diabetes mellitus (DM) treated with metformin were enrolled in study. Blood vitamin B12, MMA, homocysteine, holo-TC-II levels and hemogram values were evaluated. RESULTS Twenty-four patients were enrolled in study. Among these, 15 (62.5%) were female. The mean age of patients was 13.7±2.3 (10-19) years. Sixteen patients were diagnosed with metabolic syndrome and 8 patients were type 2 DM. At 6-month follow-up of all patients, there was no statistically significant difference in terms of vitamin B12, homocysteine, MMA and holo-TC-II levels. A 0.6% decline in vitamin B12 levels were revealed. At 12-month follow-up of 11 patients (45.8%) (6 Type 2 DM, 5 metabolic syndrome), no statistically significant difference was determined in vitamin B12, homocysteine, MMA and holo-TC-II levels. There were 6% decline in vitamin B12 levels and 10.9% increase in homocysteine levels, 5.4% decrease was detected in holo-TC-II level. CONCLUSION Although no significant changes in the serum vitamin B12, homocysteine, MMA or holo-TC-II levels with metformin therapy were detected, long-term prospective studies with high-dose metformin treatment in pediatric population are needed to confirm our results.
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Affiliation(s)
- Özen Taş
- Ankara University Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Tugba Kontbay
- Ankara University Faculty of Medicine, Pediatric Endocrinology, Ankara, Turkey
| | - Ozlem Dogan
- Ankara University Faculty of Medicine, Biochemistry, Ankara, Turkey
| | - Engin Kose
- Ankara University Faculty of Medicine, Pediatric Metabolism, Ankara, Turkey
| | - Merih Berberoglu
- Ankara University Faculty of Medicine, Pediatric Endocrinology, Ankara, Turkey
| | - Zeynep Siklar
- Ankara University Faculty of Medicine, Pediatric Endocrinology, Ankara, Turkey
| | - Leyla Tumer
- Ankara University Faculty of Medicine, Pediatric Metabolism, Ankara, Turkey
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Matsui S, Hiraishi C, Sato R, Kojima T, Ando K, Fujimoto K, Yoshida H. Associations of Homocysteine with B Vitamins and Zinc in Serum Levels of Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. J Nutr Sci Vitaminol (Tokyo) 2022; 67:417-423. [PMID: 34980720 DOI: 10.3177/jnsv.67.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The association of homocysteine metabolism-related nutrients along with renal function to homocysteine levels is not well known in patients with type 2 diabetes mellitus (T2DM). We investigated the relevance of kidney function, albuminuria, and nutritional factors to serum homocysteine in T2DM patients. This cross-sectional study enrolled 149 T2DM patients (96 men and 53 postmenopausal women), and patient characteristics and laboratory data including kidney-related data [glomerular filtration rate (eGFR), urinary albumin excretion (UACR), uric acid] and metabolism parameters (hemoglobin A1c and lipids) were collected from the medical record and serum levels of vitamin B12, folic acid, zinc, homocysteine and UACR were also acquired. In total subjects, serum levels of homocysteine, vitamin B12, and folic acid were within reference intervals, but zinc levels were close to lower limits of its reference interval. A multivariate-adjusted analysis showed that gender (β=-0.259, p<0.001), uric acid (β=0.267, p<0.001), eGFR (β=-0.188, p=0.001), log UACR (β=0.190, p=0.002), log folic acid (β=-0.259, p<0.001), log vitamin B12 (β=-0.224, p<0.001) and zinc (β=-0.169, p=0.006) were correlated to log homocysteine. In multiple regression analysis by gender, these correlations were found similarly in men, but neither log folic acid nor zinc showed correlations with log homocysteine in women. The present study suggests that renal function parameters and the certain nutritional factors have a possible influence on serum homocysteine, in T2DM patients including diabetes kidney disease.
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Affiliation(s)
- Sadako Matsui
- Food and Nutrition, Faculty of Human Sciences and Design, Japan Women's University
| | - Chika Hiraishi
- Section of Internal Medicine of Metabolism and Nutrition, The Jikei University Graduate School of Medicine
| | - Ryo Sato
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Takai Kojima
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Kiyotaka Ando
- Division of Diabetes, Metabolism and Endocrinology, The Jikei University Kashiwa Hospital
| | - Kei Fujimoto
- Division of Diabetes, Metabolism and Endocrinology, The Jikei University Daisan Hospital
| | - Hiroshi Yoshida
- Section of Internal Medicine of Metabolism and Nutrition, The Jikei University Graduate School of Medicine.,Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
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Hu Q, Li L, Zhai Z, Wang Q, Liao S. Vitamin B 12 Inhibits Streptozotocin-Induced Islet β-Cell Oxidative Stress and Apoptosis by Activating Peroxisome Proliferator-Activated Receptor- γ Signaling Pathway. J BIOMATER TISS ENG 2021. [DOI: 10.1166/jbt.2021.2778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The present study aimed to investigate the effects of vitamin B12 on islet β-cell (INS-1) induced by streptozotocin (STZ) and the potential mechanisms. In this study, CCK8 was used to detect cell viability and TUNEL assay was used to detect apoptosis levels of
treated INS-1 cells. The expression level of oxidative stress factors was measured by ELISA. Furthermore, western blot assay was used to detect the expression of PPAR-γ and apoptotic factors in treated INS-1 cells. Vitamin B12 improves STZ-induced insulin secretion
in INS-1 cells, oxidative stress injury and apoptosis. Moreover, Vitamin B12 can activate the PPAR-γ signaling pathway and inhibit STZ-induced INS-1 cell damage. Taken together, our study demonstrated that vitamin B12 inhibits streptozotocin-induced islet
β-cell oxidative stress and apoptosis by activating PPAR-γ signaling pathway.
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Affiliation(s)
- Qiaosheng Hu
- Department of Clinical Nutrition, Lianshui County People’s Hospital, Jiangsu, 223400, China
| | - Lihua Li
- Department of Clinical Nutrition, Lianshui County People’s Hospital, Jiangsu, 223400, China
| | - Zhongshu Zhai
- Department of Endocrinology, Lianshui County People’s Hospital, Jiangsu, 223400, China
| | - Quansheng Wang
- Department of Endocrinology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical Universtiy Jiangsu, 210019, China
| | - Shuaiju Liao
- Department of Endocrinology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical Universtiy Jiangsu, 210019, China
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Nwanaji-Enwerem JC, Colicino E, Gao X, Wang C, Vokonas P, Boyer EW, Baccarelli AA, Schwartz J. Associations of Plasma Folate and Vitamin B6 With Blood DNA Methylation Age: An Analysis of One-Carbon Metabolites in the VA Normative Aging Study. J Gerontol A Biol Sci Med Sci 2021; 76:760-769. [PMID: 33027507 DOI: 10.1093/gerona/glaa257] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Indexed: 02/01/2023] Open
Abstract
One-carbon metabolism is an important contributor to aging-related diseases; nevertheless, relationships of one-carbon metabolites with novel DNA methylation-based measures of biological aging remain poorly characterized. We examined relationships of one-carbon metabolites with 3 DNA methylation-based measures of biological aging: DNAmAge, GrimAge, and PhenoAge. We measured plasma levels of 4 common one-carbon metabolites (vitamin B6, vitamin B12, folate, and homocysteine) in 715 VA Normative Aging Study participants with at least 1 visit between 1999 and 2008 (observations = 1153). DNA methylation age metrics were calculated using the HumanMethylation450 BeadChip. We utilized Bayesian Kernel Machine Regression models adjusted for chronological age, lifestyle factors, age-related diseases, and study visits to determine metabolites important to the aging outcomes. Bayesian Kernel Machine Regression models allowed for the estimation of the relationships of single metabolites and the cumulative metabolite mixture with methylation age. Log vitamin B6 was selected as important to PhenoAge (β = -1.62 years, 95% CI: -2.28, -0.96). Log folate was selected as important to GrimAge (β = 0.75 years, 95% CI: 0.41, 1.09) and PhenoAge (β = 1.62 years, 95% CI: 0.95, 2.29). Compared to a model where each metabolite in the mixture is set to its 50th percentile, the log cumulative mixture with each metabolite at its 30th (β = -0.13 years, 95% CI: -0.26, -0.005) and 40th percentile (β = -0.06 years, 95% CI: -0.11, -0.005) was associated with decreased GrimAge. Our results provide novel characterizations of the relationships between one-carbon metabolites and DNA methylation age in a human population study. Further research is required to confirm these findings and establish their generalizability.
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Affiliation(s)
- Jamaji C Nwanaji-Enwerem
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, and MD/PhD Program, Harvard Medical School, Boston, Massachusetts
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Xu Gao
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York
| | - Cuicui Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Pantel Vokonas
- VA Normative Aging Study, Veterans Affairs Boston Healthcare System and the Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Edward W Boyer
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, New York
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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