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Metformin is commonly used oral hypoglycaemic agent in the treatment of type-2 Diabetes Mellitus (DM). One of the important side effect of long term metformin therapy is malabsorption of vitamin B12 which could lead to megaloblastic anemia and peripheral neuropathy. Therefore annual screening of serum vitamin B12 level or serum methylmalonic acid (MMA)/serum homocysteine level should be done in cases taking metformin for more than four to five years with average dose of >1g per day, even in the absence of haematological or neurological abnormalities. However, as the incidence of type-2 DM is increasing, cost of annual measurement of vitamin B12 level also increases. Considering cost factor for annual screening, vitamin B12 supplementation appears to be more cost effective approach rather than annual screening for routine prophylaxis. Routine vitamin preparations available in the market may contain less amount of B12 and hence are not of much therapeutic use in treatment of B12 deficiency due to Metformin. Hence there is a need to look for higher doses of approximately 500-2000μg/day.


Metformin, Type-2 Diabetes Mellitus, Vitamin B12 Deficiency.
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