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Background:
Vitamin B12 deficiency is highly prevalent among adult individuals with diabetes yet screening is infrequent in Uganda. There are currently no published data regarding the prevalence of vitamin B12 deficiency and its associated factors among adult individuals with diabetes in sub-Saharan Africa. This study aimed at describing the preva...
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Background: Vitamin B 12 deficiency has been implicated in endothelial dysfunction and cardiovascular disease via hyperhomocysteinemia. Coronary tortuosity (CorT) is a common coronary angiography finding. The etiology, clinical implication and long term prognosis are still not well clarified. This study was conducted with the aim to evaluate the re...
Citations
... The sample size was calculated using the 1965 Kish and Leslie formula based on a prevalence study from Mulago National Referral Hospital with an 18.2% prevalence of anaemia in DM patients [30]. The resulting sample size was 230 participants. ...
... Prevalence of Anaemia in Type 2 Diabetes MellitusFrom this study, the prevalence of anaemia in T2DM was 8.3% which is lower than the 18.2% reported from Mulago National Referral Hospital[30]. The difference in the findings could be attributed to the variation in the residence of the populations assessed; a large majority of our participants were rural inhabitants, whereas those from the study at Mulago were largely urban dwellers. ...
Purpose: To determine the morphological classification, associated factors and prevalence of anaemia among T2DM patients at Fort Portal Regional Referral Hospital, Southwestern Uganda. Methods: This cross-sectional study enrolled 230 T2DM patients, 60 (26.1%) males and 170 (73.9%) females. The socio-demographic characteristics were collected using structured questionnaires, 4ml of venous blood was collected from each study participant into an EDTA vacutainer. The random blood sugar level of each participant was measured using a OneTouch glucometer and recorded. The blood samples were then transported to the central laboratory for Complete Blood Counts using a SYSMEX XN 550 haematology analyser. Thin smears were made for participants who had low Hb (<12.0 g/dl for females and <13.0 g/dl for males) according to the WHO definition of anaemia. The thin films were fixed with absolute methanol and stained using May–Grünwald Giemsa stain then dried and examined for the morphological types of anaemia using ×1000 magnification. Results: The overall prevalence of anaemia in T2DM in this study was 8.3%. Anaemia was equally distributed among males and females (8.3% and 8.2% respectively). As far as morphological types of anaemia are concerned, normocytic normochromic anaemia was more prevalent, 12 (63.2%) followed by normocytic hypochromic, 3 (15.8%), microcytic normochromic, 2 (10.5%) and microcytic hypochromic, 2 (10.5%). The factors which were associated with anaemia were level of education (AOR 4.2, p-value 0.174) and age 50 years and above (AOR: 1.2, p-value 0.712). However, they were not statistically significant; p-value > 0.05. Conclusion: The prevalence of anaemia in T2DM in this study was low compared to other studies done within the country. Normocytic normochromic was the commonest type of anaemia and low level of education and age 50 years and above were associated with anaemia.
... (13,21,22) There are few studies on metformin use and associated B12 deficiency conducted in Africa. (23)(24)(25)(26) South Africa is one of the most ethnically diverse countries in Africa. Regarding race, South Africans are classified into four groups: Blacks, Whites, Coloureds, and Indians, who constitute 81.4%, 7.3%, 8.2% and 2.7% of the population, respectively. ...
... Other studies conducted in the Sub-Saharan African region also showed varying prevalence of B12 deficiency, with 6.6% in Botswana and 10.7% in Uganda. (24,25) The lack of a gold standard to diagnose B12 deficiency and the unavailability of a standardised cut-off level defining B12 deficiency may explain the varying prevalence of B12 deficiency globally. ...
Introduction: Metformin is a first-line oral hypoglycaemic agent for treating patients with type 2 diabetes mellitus (T2DM). Studies suggest that metformin use is associated with B12 deficiency. There is a paucity of data regarding this association in South Africa. The current study aimed to determine the prevalence of B12 deficiency in a South African cohort of T2DM patients on metformin therapy.
... 18 The findings in the latter study could have been explained by the fact that they not only studied Type 2 diabetic patients on metformin, but also had a smaller sample size (81) compared with our study. In Uganda, the prevalence was 10.7%, 19 while another study in Egypt found a prevalence of 6.7% in Type 1 diabetics and 10% in type 2 diabetics. 20 At a large military hospital in the USA, Pflipsen et al. found a prevalence of 22%. ...
Vitamin B12 (Vit B12) deficiency is very common among diabetic subjects, although with variable prevalence. The aim of this study is to determine the prevalence of Vit B12 deficiency and its associated factors among patients with Diabetes Mellitus (DM). This study is important because Vit B12 deficiency is associated with metformin, which is a bedrock in the management of diabetic subjects. Since peripheral neuropathy is a recognized complication of DM, and also occurs in Vit B12 deficiency, it would be important to ascertain the role of Vit B12 deficiency in the emergence of peripheral neuropathy. Appropriate measures like vitamin supplementation would then be instituted in diabetics who are on metformin. A cross-sectional study was conducted at Enugu State University Teaching Hospital in Enugu, Nigeria, between January to July 2019. A total of 422 patients who fit the eligibility criteria were included in the study. Data on demographics, medication use, and anthropometry were obtained from each subject, while blood was drawn to study Vit B12 levels, Haemoglobin (Hb), Mean Cell Volume (MCV), and Glycated Heamoglobin (HbA1c). Vitamin B12 deficiency was defined as serum B12 level of ≤200 pg/mL. The prevalence of vitamin B12 deficiency among Type 2 DM patients was 16.6% (n=364). Predictors of Vit B12 deficiency in Type 2 diabetic subjects included duration of metformin use of more than five years (p<0.0001). Other predictors of vitamin B12 deficiency include Body Mass Index (BMI), diabetes duration, and macrocytic anemia. This study suggests that the prevalence of Vit B12 deficiency among patients with DM in our population is substantial. This is more frequent among patients who have been on metformin for more than five years.
... Central obesity was associated with poor glycaemic control in four studies [16,30,52,56]. In respectively one study, the presence of anaemia [17], non-alcoholic fatty liver disease [19], vitamin B12 deficiency [20], metabolic syndrome [28], cognitive impairment [32], congestive cardiac failure [46], HIV infection [46], thyroid autoimmunity [74], and hypogonadism [45] had a significant association with poor glycaemic control. The presence of peripheral neuropathy [83] or a high-level tooth mobility index [59] was associated with poor glycaemic control. ...
Background
There is an increased burden of diabetes globally including in sub-Saharan Africa. The literature shows that glycaemic control among type 2 diabetes patients is poor in most countries in sub-Saharan Africa. Understanding the factors influencing glycaemic control in this region is therefore important to develop interventions to optimize glycaemic control. We carried out a systematic review to determine the prevalence and factors associated with glycaemic control in sub-Saharan Africa to inform the development of a glycaemic control framework in the Democratic Republic of the Congo.
Methods
We searched five databases (African Index Medicus, Africa-Wide Information, Global Health, PubMed, and Web of Science) using the following search terms: type-2 diabetes, glycaemic control, and sub-Saharan Africa. Only peer-reviewed articles from January 2012 to May 2022 were eligible for this review. Two reviewers, independently, selected articles, assessed their methodological quality using Joanna Briggs checklists, and extracted data. A meta-analysis was performed to estimate the prevalence of glycaemic control. Factors associated with glycaemic control were presented as a narrative synthesis due to heterogeneity as assessed by the I ² .
Results
A total of 74 studies, involving 21,133 participants were included in the review. The pooled prevalence of good glycaemic control was 30% (95% CI:27.6–32.9). The glycaemic control prevalence ranged from 10–60%. Younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family history of diabetes, longer duration of diabetes, pill burden, treatment regimen, side effects, use of statins or antihypertensives, alcohol consumption, smoking, presence of comorbidities/complications, and poor management were associated with poor glycaemic control. On the other hand, positive perceived family support, adequate coping strategies, high diabetes health literacy, dietary adherence, exercise practice, attendance to follow-up, and medication adherence were associated with good glycaemic control.
Conclusion
Suboptimal glycaemic control is pervasive among patients with type-2 diabetes in sub-Saharan Africa and poses a significant public health challenge. While urgent interventions are required to optimize glycaemic control in this region, these should consider sociodemographic, lifestyle, clinical, and treatment-related factors. This systematic review and meta-analysis protocol is registered in PROSPERO under CRD 42021237941.
... Four studies found that the presence of comorbidities was associated with poor glycaemic control [53,75,77,87] In respectively one study, the presence of anaemia [17], non-alcoholic fatty liver disease [19], vitamin B12 de ciency [20] [59] was associated with poor glycaemic control. Overall health-related quality of life was inversely associated and FBG [42]. ...
Background
There is an increased burden of diabetes globally including in sub-Saharan Africa. The literature shows that the control of type-2 diabetes is generally poor in most countries in sub-Saharan Africa. Gaining an understanding of the factors influencing glycaemic control in this region is therefore important to develop interventions to optimize glycaemic control. We carried out a systematic review to determine the prevalence and factors associated with glycaemic control in sub-Saharan Africa to inform the development of a glycaemic control framework in the Democratic Republic of the Congo.
Methods
We searched five databases (African Index Medicus, Africa-Wide Information, Global Health, PubMed, and Web of Science) using the following search terms: type-2 diabetes, glycaemic control, and sub-Saharan Africa. Only peer-reviewed articles from January 2012 to May 2022 were eligible for this review. Two reviewers, independently, selected articles, assessed their methodological quality using Joanna Briggs checklists, and extracted data. A meta-analysis was performed to estimate the prevalence of glycaemic control. Factors associated with glycaemic control were presented as a narrative synthesis due to heterogeneity as assessed by the I².
Results
A total of 74 studies, involving 21,133 participants were included in the review. The pooled prevalence of glycaemic control was 30%. The highest glycaemic control reported was 60%. The factors significantly associated with glycaemic control were categorized into six groups: sociodemographic (younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family support, coping strategies), lifestyle (dietary adherence, practice of exercise, smoking, alcohol consumption), clinical (family history of diabetes, longer duration of diabetes, presence of comorbidities/complications), adherence (attendance to follow-up, medication adherence), treatment modalities (pill burden, treatment regimen, use of statins or anti-hypertensives, education about diabetes, definition of glycaemic goals), and glycaemic control optimization interventions.
Conclusion
Sub-optimal glycaemic control is pervasive among patients with type-2 diabetes in sub-Saharan Africa and poses a significant public health challenge. While urgent interventions are required to optimize glycaemic control in this region, these should be taken account of sociodemographic, lifestyle, clinical and treatment-related factors. This systematic review and meta-analysis protocol is registered in PROSPERO under CRD 42021237941.
... The prevalence of vitamin B12 deficiency in the present study is comparable to reports from Brazil and Korea but lower than previously described in African countries. 8,[19][20][21] For instance, the prevalence of vitamin B12 deficiency in South Africa and Uganda was (28%) and (10.7%), respectively. 20,21 The variations in diets across communities may partly explain the differences in the prevalence of vitamin B12 deficiency across studies. ...
... 8,[19][20][21] For instance, the prevalence of vitamin B12 deficiency in South Africa and Uganda was (28%) and (10.7%), respectively. 20,21 The variations in diets across communities may partly explain the differences in the prevalence of vitamin B12 deficiency across studies. The high consumption of meat among the Botswana population may explain the lower prevalence of vitamin B12 in our population than in other African settings. ...
Objective
To estimate the prevalence of Vitamin B12 deficiency among patients with diabetes.
Methodology
This cross-sectional study was undertaken on 351 patients with diabetes at a specialised public diabetes clinic in Gaborone between July 2017 and October 2017. Clinical, anthropometry and laboratory data were collected. Vitamin B12 deficiency was defined by levels < 150 pmol/l.
Results
The mean (SD) age of the participants was 57 (15) years, two-thirds (67.2%) were females, and the majority (92.9%) had Type 2 diabetes. Most (89.5%) participants were on metformin. The prevalence of vitamin B12 deficiency was 6.6%. Compared with participants with normal Vitamin B12 levels, deficient participants were significantly older (64 vs. 56 years, p = 0.014) and had a longer duration of metformin use (7 vs. 4 years, p = 0.024). The use of acid blockers was also associated with vitamin B12 deficiency (p = 0.012). There was no difference in the prevalence of peripheral neuropathy between those with normal and deficient vitamin B12 levels.
Conclusion
Vitamin B12 deficiency exists among patients with diabetes in the setting discussed. Regular vitamin B12 assessment may be beneficial, especially among diabetes patients who are old, those taking metformin over a long duration and patients on acid blockers.
... Long-term usage of metformin has been reported to be associated with intestinal malabsorption of vitamin B 12 culminating in vitamin B 12 deficiency with likely associated haematologic abnormalities (including macro-ovalocytic anaemia and immune dysfunctioning due to hypersegmentation of polymorphonuclear leukocytes), central/peripheral neuropathy and manifestation of biochemical derangements such as elevated homocysteine and methyl malonate (MMA) levels. 1,2 The metformin-induced vitamin B 12 deficiency state, also known and referred to as metformin-induced hypocobalaminemia (due to metformin-vitamin B 12 interaction) belongs to the category form of mild/minor (type B) drugnutriceutical interaction whose medico-clinical significance is acutely unknown, until when taken chronically for more than average of 5 years before gradual decrease in plasma vitamin B 12 level will begin to ensue as a result of hepatic and muscular storage sites depletion. It is also a form of mild adverse drug reaction (ADR) whose occurrence is duration of use-dependent (type C/chronic use ADR) and onset prolongation-dependent (type D/delay-onset ADR). ...
... According to the year 2014 annual report of the International Diabetes Federation, the estimated prevalence of diabetes mellitus (DM) was 4.6% in Nigeria. 1,2 In 2016, an estimated 422 million adults globally are said to be living with DM according to World Health Organization. 3 The management of type 2 DM involves the use of several oral hypoglycaemic agents; however, metformin is widely used as a first-line pharmacotherapeutic agent in conjunction with dietary modifications. ...
... A similar result was reported among the Palestinians where a statistically significant strong positive correlation was seen between PCV and serum vitamin B 12 level (p ¼ 0.001). 7 Akabwai et al. 2 also reported an association between Hb concentrations and serum vitamin B 12 levels among Ugandan population. The low level of PCV seen among the participants in this study could be as result of their poor socio-economic status, as most of them are rural area dwellers and low income earners. ...
Background
Metformin-induced vitamin B 12 deficiency state or metformin-induced hypocobalaminemia is gradually becoming an epidemic among diabetic patients on moderate-to-high doses of metformin or those diabetic patients on metformin for a long period of time. The potential effect of chronic metformin pharmacotherapy to cause vitamin B 12 deficiency with abnormalities in haematologic indices and central/peripheral neuropathy has been widely reported. Long-term usage of metformin has been reported to be associated with intestinal malabsorption of vitamin B 12 culminating in vitamin B 12 deficiency with likely associated haematologic abnormalities (including macro-ovalocytic anaemia and immune dysfunctioning due to hypersegmentation of polymorphonuclear leukocytes), central/peripheral neuropathy and manifestation of biochemical derangements such as elevated homocysteine and methyl malonate levels.
Aim
This study aimed to determine the correlation between serum vitamin B 12 levels and various haematologic indices among metformin-treated type 2 diabetic patients in a clinical practice setting with the rational purpose of alleviating/preventing the associated derangements.
Materials and Methods
This was a case-control, prospective, analytical, observational study of 200 adult participants (100 per group) attending the Endocrinology Out-patients Clinic of Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria. For each participant, serum vitamin B 12 level was determined using a vitamin B 12 immunoassay technique, while the corresponding complete blood count was done using PCE-210N autohaematology analyser. Data were presented using tables and figures. Chi-square test was used to compare categorical variables, Student t-test was used in comparing means of continuous variables, while Pearson’s correlation study was done to determine the existence of any statistically significant correlation(s) between the serum vitamin B 12 levels and various haematologic indices among the participants.
Results
Approximately 41% versus 20% of the metformin-treated and metformin-naive diabetic patients, respectively, had frank vitamin B 12 deficiency. There was a statistical difference between the total serum vitamin B 12 levels in male and female diabetic patients with p = 0.048. Also, statistically significant differences existed with respect to mean corpuscular volume (MCV), mean corpuscular haemoglobin and total white blood cells count among the metformin-treated and metformin-naive diabetic patients. Furthermore, a statistically significant weak positive correlation existed between pack cell volume (PCV) and serum vitamin B 12 level ( r = +0.148, p = 0.037), but a statistically significant weak negative correlation existed between MCV and serum vitamin B 12 level ( r = −0.245, p = 0.0001). In addition, the test for associations between the serum vitamin B 12 categorization status or metformin exposure status and the peripheral neuropathy components assessment revealed that there were statistically significant associations between the serum vitamin B 12 categorization status or metformin exposure status versus pain sense ( p < 0.0001 or <0.001), vibration sense ( p < 0.0001 or <0.001) and light touch sense ( p < 0.0001 or <0.001) among the participants.
Conclusion
In this study, statistically significant weak positive and weak negative correlations existed between serum vitamin B 12 level versus PCV, and serum vitamin B 12 level versus MCV, respectively. The peripheral neuropathy components assessment revealed that there were statistically significant associations between the serum vitamin B 12 categorization status or metformin exposure status versus pain sense, vibration sense and light touch sense among the participants.
... Hyper homo cysteineemia, which has been demonstrated as a hazard factor for complications associated with T2DM and hypertension (Malouf, et al. 2003)., earlier clinical and community based studies have shown a high prevalence of Vit. B12 deficiency in adults with T2DM (Akabwai, et al. 2016).,new report suggests that metformin use is correlated with a decline in terminal iliac absorption of Vit. ...
Background: Diabetes Mellitus (DM) is the most prevalent metabolic unrest affecting the people all over the world. Vitamin B12 (Vit B12), is a water-soluble vitamin, one of the eight B vitamins, metabolically important Vit B12 deficiency later will consequence in diabetes-related complications. current data was undertaken to exploration of the relationship of Vit B12 with some anthropometric measurements in type2 diabetic patients. Materials and methods: This study consisted of 60 patients with T2DM, attending Al-Ramadi teaching hospital and Al-Fallujah teaching hospital and 24 healthy individuals as controls. Serum Vit. B12 level was determined by ELISA technique while weight, height, waist, thoracic, neck,
... Similar studies done in Europe have reported a prevalence of about 27%. 16,17 Akabwai et al. 18 , Study has shown that the prevalence of vitamin B12 deficiency was 10. 7%. Hemoglobin level < 12 g/dl and glycated hemoglobin ≥ 7% were associated with vitamin B12 deficiency. ...
Background and objectives:Vitamin B12 deficiency is prevalent among patients with type 2 diabetes mellitus, es- pecially those using Metformin for a long period of time. The aim of this study was to determine the association and prevalence of vitamin B12 deficiency among Kurdish patients with type 2 diabetes mellitus on metformin therapy and its associated clinical complications. Methods: This cross-sectional study was conducted in the Diabetes and Endocrine Center of Sulaimani city. Data, including past medical history, medication history and blood samples, were collected from 223 participants to measure fasting blood sugar, blood cells counts, HbA1c, renal function and serum B12 level. Results: This study found a high prevalence of vitamin B12 deficiency, 24.6% in patients with type 2 dia- betes mellitus on Metformin therapy. There was a significant difference between mean B12 levels of those with B12 deficiency (145.24 ± 32.88 pg/ml) and those with normal serum B12 level (387.62 ±281.44 pg/ml). No relationship existed between vitamin B12 levels and the dose and duration of metformin use. However, there was a statically significant relationship between serum vitamin B12 and peripheral neuropathy. Conclusions: Prevalence of vitamin B12 deficiency among patients using Metformin is high, but there is no significant effect of the dose and duration of Metformin exposure on B12 concentration. Additionally, there’s a significant relationship between the presence of neuropathy and B12 level.
