Posters
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Research/Clinical
Abstract
Background: Metformin is the most widely used oral, anti-hyperglycemic medication, prescribed to more than 100 million people across the entire globe (1). Although Metformin has proven beneficial for patients with pre-diabetes, type 2 diabetes, insulin resistance, and PCOS, studies have also shown its use may be associated with vitamin B12 deficiency. Due to a lack of screening criteria, B12 deficiency is likely unrecognized in the ambulatory setting. Our project aimed to improve screening for vitamin B12 deficiency in our clinic amongst patients with diabetes on long-term metformin therapy.
Methods: Clinic data was collected from July 1st, 2020, to July 1st, 2022, for a retrospective analysis. After analyzing the initial data, our intervention was initiated as a lecture educating our UTRGV-DHR internal medicine residents on vitamin B12 screening in patients taking Metformin. After the intervention, clinic data was securely collected from January 13th, 2023, to March 1st, 2023, for proper analysis to compare the rates of vitamin B12 screening before and after the intervention.
Results: Of 266 patients in our preintervention data, 164 met the exclusion criteria. Of the remaining 102 patients, 18 were appropriately screened for B12 deficiency in the setting of metformin use, equivalent to 17.65% of the total population. Only three patients were found to have B12 deficiency, and all of them received appropriate treatment. After the intervention, the patient´s charts were again evaluated to assess for change in the screening rate. Of the initial 102 patients who met the selection criteria, only 53 were followed up post-intervention. Eight patients were screened for vitamin B12 deficiency, equivalent to 15.09% of the total population. Of these eight patients, two patients did not have a result available on the medical records, four patients had normal B12 levels, and two patients were found to have B12 deficiency. Only 1 of 2 patients received appropriate treatment since the second patient was also lost to follow-up.
Conclusion: Our intervention did not result in an increased screening rate for B12 deficiency in the ambulatory setting. Despite our efforts, our project had multiple limitations, including an underserved patient population, elevated test costs, a high rate of patients lost to follow-up, and the impact of COVID-19 in healthcare during 2020 and 2021. Further studies are needed to evaluate if Vitamin B12 should be part of the routine screening of Diabetic patients on Metformin.
Academic/Professional Position
Resident
Mentor/PI Department
Internal Medicine
Recommended Citation
Haj-yahya, Khairiya; Gomez Casanovas, Jose G.; Aquino, Alejandro; Sanchez, Eric; Rivera, Jose; Rincon-Rueda, Laura; Baird, Andreina; Nadal, Jorge; Solis, Martha; and Suarez Parraga, Andres R., "Evaluation of Vitamin B12 levels in patients with Type 2 Diabetes Mellitus taking Metformin in the ambulatory care setting" (2024). Research Symposium. 93.
https://scholarworks.utrgv.edu/somrs/2023/posters/93
Included in
Evaluation of Vitamin B12 levels in patients with Type 2 Diabetes Mellitus taking Metformin in the ambulatory care setting
Background: Metformin is the most widely used oral, anti-hyperglycemic medication, prescribed to more than 100 million people across the entire globe (1). Although Metformin has proven beneficial for patients with pre-diabetes, type 2 diabetes, insulin resistance, and PCOS, studies have also shown its use may be associated with vitamin B12 deficiency. Due to a lack of screening criteria, B12 deficiency is likely unrecognized in the ambulatory setting. Our project aimed to improve screening for vitamin B12 deficiency in our clinic amongst patients with diabetes on long-term metformin therapy.
Methods: Clinic data was collected from July 1st, 2020, to July 1st, 2022, for a retrospective analysis. After analyzing the initial data, our intervention was initiated as a lecture educating our UTRGV-DHR internal medicine residents on vitamin B12 screening in patients taking Metformin. After the intervention, clinic data was securely collected from January 13th, 2023, to March 1st, 2023, for proper analysis to compare the rates of vitamin B12 screening before and after the intervention.
Results: Of 266 patients in our preintervention data, 164 met the exclusion criteria. Of the remaining 102 patients, 18 were appropriately screened for B12 deficiency in the setting of metformin use, equivalent to 17.65% of the total population. Only three patients were found to have B12 deficiency, and all of them received appropriate treatment. After the intervention, the patient´s charts were again evaluated to assess for change in the screening rate. Of the initial 102 patients who met the selection criteria, only 53 were followed up post-intervention. Eight patients were screened for vitamin B12 deficiency, equivalent to 15.09% of the total population. Of these eight patients, two patients did not have a result available on the medical records, four patients had normal B12 levels, and two patients were found to have B12 deficiency. Only 1 of 2 patients received appropriate treatment since the second patient was also lost to follow-up.
Conclusion: Our intervention did not result in an increased screening rate for B12 deficiency in the ambulatory setting. Despite our efforts, our project had multiple limitations, including an underserved patient population, elevated test costs, a high rate of patients lost to follow-up, and the impact of COVID-19 in healthcare during 2020 and 2021. Further studies are needed to evaluate if Vitamin B12 should be part of the routine screening of Diabetic patients on Metformin.