Evaluation of vitamin B12 monitoring in patients on metformin in urban ambulatory care settings
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| Formato: | Artículo científico |
| Lenguaje: | en |
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Centro de investigaciones y Publicaciones Farmacéuticas
2019
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| _version_ | 1876453969828511744 |
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| author | Stacy L. Longo |
| author_facet | Stacy L. Longo |
| contents | Evaluation of vitamin B12 monitoring in patients on metformin in urban ambulatory care settings Stacy L. Longo Jessica M. Ryan Kelsey B. Sheehan Debra J. Reid Michael P. Conley Carla J. Bouwmeester Medicina Type 2 Practice Metformin Attitudes Prevalence Background: Previous studies linked metformin use to vitamin B12 deficiency and demonstrated that the prevalence of vitamin B12 monitoring remains low.Objective: This study aimed to assess the occurrence of monitoring vitamin B12 levels in a diverse population.Methods: This was a retrospective chart review of adult patients with type 2 diabetes on metformin doses ≥ 1000 mg for ≥ 6 months at five Federally Qualified Health Centers (FQHC) and one Program of All-Inclusive Care for the Elderly (PACE). Charts were reviewed for occurrence of monitoring vitamin B12 levels in the past 5 years. Data collected included patient demographics, laboratory data, other potential vitamin B12 level lowering agents, active prescription for vitamin B12 supplementation, concomitant diabetes medications and metformin total daily dose.Results: Of the 322 patients included, 25% had a vitamin B12 level measured in the previous five years. Among the patients with a vitamin B12 level, 87.7% were within the normal range (>350 pg/mL), 11.1% were low (200-300 pg/mL), and only one patient (1.2%) was deficient (<200 pg/mL). These patients were older (69.2 vs. 56.4, p<0.001); more likely to be white (56.8% vs. 37.8%, p=0.04); and more likely to use proton pump inhibitors (34.6% vs. 20.7%, p=0.02) and vitamin B12 supplementation (27.2% vs. 4.6%, p<0.001). Vitamin B12 monitoring differed between the FQHC (15.2%) and PACE (97.4%) sites (p<0.001). Each greater year of age was associated with a 5% increased odds of vitamin B12 monitoring (a OR: 1.05; 95% CI: 1.02-1.08).Conclusions: The majority of patients seen at the FQHC sites did not have vitamin B12 levels monitored, however, most of the patients who were monitored had normal vitamin B12 levels, which may warrant extending the monitoring time. This finding may also support monitoring patients who have additional risk factors for vitamin B12 deficiency such as concurrent medication use with other vitamin B12 lowering agents or clinical symptoms of deficiency such as peripheral neuropathy. Future studies are needed to determine appropriate frequency of monitoring. 2019 artículo científico 1885-642X https://www.redalyc.org/articulo.oa?id=69061088006 https://www.redalyc.org/journal/690/69061088006/ https://www.redalyc.org/journal/690/69061088006/html/ https://www.redalyc.org/journal/690/69061088006/69061088006.epub https://www.redalyc.org/journal/690/69061088006/movil 10.18549/PharmPract.2019.3.1611 en http://www.redalyc.org/revista.oa?id=690 Pharmacy Practice application/pdf Centro de investigaciones y Publicaciones Farmacéuticas Pharmacy Practice (España) Num.3 Vol.17 |
| format | Artículo científico |
| id | redalyc_69061088006 |
| institution | Redalyc |
| language | en |
| publishDate | 2019 |
| publisher | Centro de investigaciones y Publicaciones Farmacéuticas |
| spellingShingle | Evaluation of vitamin B12 monitoring in patients on metformin in urban ambulatory care settings Stacy L. Longo Medicina Type 2 Practice Metformin Attitudes Prevalence Evaluation of vitamin B12 monitoring in patients on metformin in urban ambulatory care settings Stacy L. Longo Jessica M. Ryan Kelsey B. Sheehan Debra J. Reid Michael P. Conley Carla J. Bouwmeester Medicina Type 2 Practice Metformin Attitudes Prevalence Background: Previous studies linked metformin use to vitamin B12 deficiency and demonstrated that the prevalence of vitamin B12 monitoring remains low.Objective: This study aimed to assess the occurrence of monitoring vitamin B12 levels in a diverse population.Methods: This was a retrospective chart review of adult patients with type 2 diabetes on metformin doses ≥ 1000 mg for ≥ 6 months at five Federally Qualified Health Centers (FQHC) and one Program of All-Inclusive Care for the Elderly (PACE). Charts were reviewed for occurrence of monitoring vitamin B12 levels in the past 5 years. Data collected included patient demographics, laboratory data, other potential vitamin B12 level lowering agents, active prescription for vitamin B12 supplementation, concomitant diabetes medications and metformin total daily dose.Results: Of the 322 patients included, 25% had a vitamin B12 level measured in the previous five years. Among the patients with a vitamin B12 level, 87.7% were within the normal range (>350 pg/mL), 11.1% were low (200-300 pg/mL), and only one patient (1.2%) was deficient (<200 pg/mL). These patients were older (69.2 vs. 56.4, p<0.001); more likely to be white (56.8% vs. 37.8%, p=0.04); and more likely to use proton pump inhibitors (34.6% vs. 20.7%, p=0.02) and vitamin B12 supplementation (27.2% vs. 4.6%, p<0.001). Vitamin B12 monitoring differed between the FQHC (15.2%) and PACE (97.4%) sites (p<0.001). Each greater year of age was associated with a 5% increased odds of vitamin B12 monitoring (a OR: 1.05; 95% CI: 1.02-1.08).Conclusions: The majority of patients seen at the FQHC sites did not have vitamin B12 levels monitored, however, most of the patients who were monitored had normal vitamin B12 levels, which may warrant extending the monitoring time. This finding may also support monitoring patients who have additional risk factors for vitamin B12 deficiency such as concurrent medication use with other vitamin B12 lowering agents or clinical symptoms of deficiency such as peripheral neuropathy. Future studies are needed to determine appropriate frequency of monitoring. 2019 artículo científico 1885-642X https://www.redalyc.org/articulo.oa?id=69061088006 https://www.redalyc.org/journal/690/69061088006/ https://www.redalyc.org/journal/690/69061088006/html/ https://www.redalyc.org/journal/690/69061088006/69061088006.epub https://www.redalyc.org/journal/690/69061088006/movil 10.18549/PharmPract.2019.3.1611 en http://www.redalyc.org/revista.oa?id=690 Pharmacy Practice application/pdf Centro de investigaciones y Publicaciones Farmacéuticas Pharmacy Practice (España) Num.3 Vol.17 |
| title | Evaluation of vitamin B12 monitoring in patients on metformin in urban ambulatory care settings |
| topic | Medicina Type 2 Practice Metformin Attitudes Prevalence |
| url | https://www.redalyc.org/articulo.oa?id=69061088006 https://www.redalyc.org/journal/690/69061088006/ https://www.redalyc.org/journal/690/69061088006/html/ https://www.redalyc.org/journal/690/69061088006/69061088006.epub https://www.redalyc.org/journal/690/69061088006/movil |