Evaluation of Serum Vitamin B12 Monitoring and Metformin Use in the Salisbury Veterans Affairs Health Care System (SVAHCS) Meagan Jenkins, Camille Robinette Salisbury VA Medical Center - Salisbury, NC
Background/Purpose: Metformin hydrochloride is a biguanide, antihyperglycemic agent utilized as a first-line treatment for type 2 diabetes mellitus. Use of metformin has been associated with deficiency of vitamin B12, a coenzyme involved in DNA synthesis, folate metabolism, erythropoiesis, neurodevelopment, and nervous system functioning. Vitamin B12 deficiency can lead to anemia, central and peripheral neuropathies, and hyperhomocysteinemia. The 2018 American Diabetes Association (ADA) guidelines suggest consideration of periodic vitamin B12 monitoring in patients taking metformin, particularly in those with anemia or peripheral neuropathy. The purpose of this evaluation is to assess monitoring patterns of serum vitamin B12 in metformin users at the SVAHCS and evaluate the need for increased consideration and clinical advocacy of vitamin B12 monitoring in this population.
Methodology: Retrospective, quality improvement chart review. Electronic medical records for a randomly selected subset of patients with continuously active outpatient prescriptions for metformin throughout the period of January 01, 2014 to December 31, 2017 were assessed for age, concurrent anemia and/or neuropathy, and serum vitamin B12 level monitoring.
Presentation Objective: Describe monitoring patterns of serum vitamin B12 in metformin users at the Salisbury VAHCS and describe the potential impact of increased consideration and clinical advocacy of vitamin B12 monitoring in metformin users.
Self-Assessment: What are some reasons to monitor vitamin B12 in metformin users?