Letter to the Editor

Response to "More Adverse Neurological Consequences of Metformin-Induced Vitamin B12 Deficiency"

Authors: David S.H. Bell, MB, FACE

Abstract

To the Editor:


In my case report, my intention was to warn physicians that vitamin B12 deficiency could be induced with long-term metformin therapy.1The clinical findings in this case indicated that the neuropathy was entirely due to vitamin B12 deficiency and not to diabetes. Subsequently, Wile and Toth reported that metformin-induced vitamin B12 deficiency, as best assessed by methylmalonic acid (MMA) elevation, exacerbates diabetic neuropathy as judged by both clinical and electrophysiological parameters.2 Furthermore, these changes could occur as early as six months after metformin initiation.

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References

1. Bell DS. Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy. South Med J 2010;103:265-267.
 
2. Wile DJ, Toth C. Association of metformin, elevated homocysteine, and methylmalonic acid levels and clinically worsened diabetic peripheral neuropathy. Diabetes Care 2010;33:156-161.