Citation Information :
Vayarvel CA, Velu VK, Hussain SA, Ramasamy R. Association of Insulin Resistance with Vitamin B12 Status in Type 2 Diabetes Mellitus Patients on Metformin Therapy. 2020; 3 (1):16-18.
Introduction: Association of insulin resistance with obesity and metabolic syndrome is an established fact. Vitamin B12 deficiency resulting from metformin therapy in type 2 diabetes mellitus (T2DM) patients was documented in the literature. In our study, we tried to explore the association of insulin resistance with vitamin B12 deficiency in T2DM patients on metformin therapy. Materials and methods: A total of 120 T2DM patients on metformin for at least 6 months with minimum dose of 1,000 mg/day between age group 35 years and 55 years were included. They were divided into group I (with B12 deficiency) and group II (with normal B12 levels). Patients who were on multivitamin supplementation or B12 therapy, nutritional deficiency of vitamin B12, or with any coexisting cause of B12 deficiency like alcoholism, liver, thyroid, and cardiac diseases were excluded from the study. Following biochemical parameters were estimated: fasting plasma glucose, fasting plasma insulin, and vitamin B12. Homocysteine and HOMO-IR were calculated. The statistical analysis, such as Student\'s t-test and Pearson correlation test, was performed. Results: B12 deficiency (group I) showed significant increase in insulin resistance. A negative correlation was observed between vitamin B12 and HOMA IR. Homocysteine showed positive correlation with HOMA IR. Conclusion: There is a negative correlation between the levels of vitamin B12 and insulin resistance and a positive correlation between homocysteine and insulin resistance in T2DM patients on metformin therapy.
King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 1998;21(9):1414–1431. DOI: 10.2337/diacare.21.9.1414.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27(5):1047–1053. DOI: 10.2337/diacare.27.5.1047.
International Diabetes Federation. The diabetes atlas, 6th ed. Poster update. 2014. Available at http://www.idf.org/sites/default/files/Atlas-poster2014_EN.pdf. [Accessed 2 February 2015].
Weyer C, Bogardus C, Mott DM, Pratley RE. The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. J Clin Invest 1999;104(6):787–794. DOI: 10.1172/JCI7231.
Belhayara MI, Mellouk Z, Hamdaoui MS, Bachaoui M, Kheroua O, Malaisse WJ. The metabolic syndrome: emerging novel insights regarding the relationship between the homeostasis model assessment of insulin resistance and other key predictive markers in young adults of western Algeria. Nutrients 2020;12(3):727. DOI: 10.3390/nu12030727.
Ye J. Mechanisms of insulin resistance in obesity. Front Med 2013;7(1):14–24. DOI: 10.1007/s11684-013-0262-6.
Khan A, Shafiq I, Hassan Shah M. Prevalence of vitamin b12 deficiency in patients with type II diabetes mellitus on metformin: a study from Khyber Pakhtunkhwa. Cureus 2017;9(8):e1577. DOI: 10.7759/cureus.1577.
Akinlade KS, Agbebaku SO, Rahamon SK, Balogun WO. Vitamin B 12 levels in patients with type II diabetes mellitus on metformin. annals of Ibadan. Postgrad Med 2015;13:79–83.
Martin C. The role of vitamins in the prevention and treatment of type 2 diabetes and its complications. J Diabetes Nurs 2013;17:378–383.
Pflipsen MC, Oh RC, Saguil A, Seehusen DA, Seaquist D, Topolski R. The prevalence of vitamin B12 deficiency in patients with type 2 diabetes: a cross-sectional study. J Am Board Fam Med 2009;22(5):528–534. DOI: 10.3122/jabfm.2009.05.090044.
Reinstatler L, Qi YP, Williamson RS, Garn JV, Oakley GPJr. 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(2):327–333. DOI: 10.2337/dc11-1582.
Krishnaveni GV, Hill JC, Veena SR, Bhat DS, Wills AK, Karat CLS, et al. Low plasma vitamin B12 in pregnancy is associated with gestational ‘diabesity’ and later diabetes. Diabetologia 2009;52(11):2350–2358. DOI: 10.1007/s00125-009-1499-0.
Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore) 2019;98(46):e17918. DOI: 10.1097/MD.0000000000017918.
Li Z, Gueant-Rodriguez RM, Quilliot D, Sirveaux MA, Meyre D, Gueant JL, et al. Folate and vitamin B12 status is associated with insulin resistance and metabolic syndrome in morbidobesity. Clin Nutr 2017;37(5):1700–1706. DOI: 10.1016/j.clnu.2017.07.008.
Yang N, Yao Z, Miao L, Liu J, Gao X, Fan H, et al. Novel clinical evidence of an association between homocysteine and insulin resistance in patients with hypothyroidism or subclinical hypothyroidism. PLoS One. 2015;10(5):e0125922. DOI: 10.1371/journal.pone.0125922.
Li Y, Zhang H, Jiang C, Xu M, Pang Y, Feng J, et al. Hyperhomocysteinemia promotes insulin resistance by inducing endoplasmic reticulum stress in adipose tissue. J Biol Chem 2013;288(14):9583–9592. DOI: 10.1074/jbc.M112.431627.
Meigs JB, Jacques PF, Selhub J, Singer DE, Nathan DM, Rifai N, et al. Framingham offspring study. fasting plasma homocysteine levels in the insulin resistance syndrome: the Framingham offspring study. Diabetes Care 2001;24(8):1403–1410. DOI: 10.2337/diacare.24.8.1403.