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The Prevalence of Vitamin B₁₂ Deficiency in Patients with Type 2 Diabetes: A Cross-Sectional Study

Department of Primary Care, Raymond W Bliss Army Health Center, Ft. Huachuca, AZ (MCP)
Department of Family Medicine, Tripler Army Medical Center, Honolulu, HI (RCO)
Department of Family and Community Medicine, Eisenhower Army Medical Center, Fort Gordon, GA (AS, DAS)
Department of Psychology, Augusta State University, Augusta, GA (RT)

Correspondence: Corresponding author: Matthew C Pflipsen, MD, 2240 E Winrow Ave, Department of Primary Care, Raymond W Bliss Army Health Center, Ft. Huachuca, AZ 85613 (E-mail: matthew.pflipsen{at}us.army.mil)

Purpose: The purpose of this study is to define the prevalence of vitamin B₁₂ deficiency in a type 2 diabetic population within a primary care practice. Metformin use and advanced age are associated with vitamin B₁₂ deficiency and often present in type 2 diabetic patients, yet the prevalence of vitamin B₁₂ deficiency in the diabetic population is unknown.

Methods: We conducted a cross-sectional study of 203 outpatient type 2 diabetic patients at a large military primary care clinic. Patients completed a survey and had B₁₂ levels measured. Patients with borderline B₁₂ levels also had methylmalonic acid and homocysteine levels drawn. Serum B₁₂ levels <100 pg/mL or serum B₁₂ levels of 100 to 350 pg/mL with elevation of serum methylmalonic acid >243 nmol/L or homocysteine >11.9 nmol/L defined B₁₂ deficiency. Descriptive statistics described frequency and means. ² and student's t tests were used to analyze associations between categorical and continuous variables, respectively. Multivariate logistical regression identified covariates independently associated with B₁₂ deficiency.

Results: Twenty-two percent (n = 44) of diabetic patients had metabolically confirmed B₁₂ deficiency. Patients on metformin had lower serum B₁₂ levels (425.99 pg/mL vs 527.49 pg/mL; P = .012) and were at increased risk for B₁₂ deficiency (P = .04), as defined by a serum B₁₂ level <350 pg/mL. Prevalence of B₁₂ deficiency was significantly lower for patients using a multivitamin (odds ratio, 0.31; 95% CI, 0.15–0.63).

Conclusions: Our results found a 22% prevalence of metabolically confirmed B₁₂ deficiency in the primary care type 2 diabetic population. Although further research needs to be performed to determine the clinical implications of our findings, B₁₂ deficiency should be considered in type 2 diabetic patients, especially those taking metformin. Furthermore, a daily multivitamin may protect against B₁₂ deficiency.

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