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©The Author(s) 2025.
World J Diabetes. Jul 15, 2025; 16(7): 107514
Published online Jul 15, 2025. doi: 10.4239/wjd.v16.i7.107514
Published online Jul 15, 2025. doi: 10.4239/wjd.v16.i7.107514
Table 1 Clinical guideline recommendations on metformin-induced vitamin B12 deficiency
Guideline | Recommendation | Monitoring frequency | Treatment | Ref. |
British Committee for Standards in Haematology | Does not recommend routine screening, but suggests evaluation if clinical suspicion exists; highlights the importance of ruling out pernicious anemia | Not specified | If due to metformin: Oral cobalamin 50 μg/day for 1 month; prophylactic supplementation not recommended | [46] |
American Association of Clinical Endocrinologists and American College of Endocrinology-Clinical Practice Guidelines-2015 | Mentions the risk of deficiency in metformin users | Not specified | No treatment specified | [40] |
Diabetes Canada | Does not mention vitamin B12 deficiency | Not mentioned | Not mentioned | [42] |
Diabetes Research and Clinical Practice-2023 | Mentions vitamin B12 only as a differential diagnosis | Not mentioned | Not mentioned | |
Vitamin B12 deficiency in over 16 seconds: Diagnosis and management, guidance NICE | Recommend screening in patients with at least one symptom and one risk factor (such as metformin use) | Not specified | Oral or IM vitamin B12; reevaluate after 3 months; consider discontinuing metformin if it is the cause | [38] |
ADA Standards of Care in Diabetes-2025 | Acknowledges the risk of deficiency in patients with neuropathy or anemia, especially those taking > 1500 mg/day or using it for > 4-5 years | Periodic monitoring recommended, no specific interval defined | No specific treatment recommended | [39] |
- Citation: Alvarez M, Prieto AE, Portilla N, Moya D, Rincon O, Guzman I. Metformin-induced vitamin B12 deficiency: An underdiagnosed cause of diabetic neuropathy. World J Diabetes 2025; 16(7): 107514
- URL: https://www.wjgnet.com/1948-9358/full/v16/i7/107514.htm
- DOI: https://dx.doi.org/10.4239/wjd.v16.i7.107514