ABSTRACT
Background: Metformin is first line of treatment in type 2 diabetes mellitus (T2DM). It has been reported to be associated with vitamin B12 deficiency with variable results in various studies. The aim of our study is to correlate metformin use and vitamin B12 levels in patients of T2DM with high prevalence in Sub-Himalyan region of north India.Methods: The study was conducted from August 2017 to July 2018 enrolling 124 patients, aged 18 years and above with T2DM taking metformin treatment for >4 months. Vitamin B12 levels were estimated and the levels <200, 200-300 and >300 pg/ml were defined as having definite deficiency, borderline deficiency and normal levels respectively.Results: A total of 124 patients included 66 (53.2%) male and 58 (46.8%) female patients with T2DM on metformin treatment. The mean vitamin B12 level was found significantly low, 176.23±60.96 pg/ml and 18 (14.5%) patients were found to have significant vitamin B12 deficiency and 8(6.5%) patients, borderline deficiency in longer duration of metformin use for >10 years (p<0.001). Vitamin B12 deficiency was found significantly more in 14 (11.3%) patients taking lower doses ≤1000 mg/day of metformin compared to higher doses, a negative correlation. Peripheral neuropathy was significantly present in 15.3% of patients in metformin induced vitamin B12deficiency.Conclusions: Vitamin B12 deficiency was found to be significantly correlated to longer duration of metformin treatment and neuropathy in T2DM but negatively correlated to higher doses of metformin. Therefore, we recommend the assessment and supplementation of vitamin B12 in metformin use in T2DM, compromising financial burden but not the outcome of its deficiency.
ABSTRACT
Background: The cerebrospinal fluid (CSF) analysis is an invaluable diagnostic aid in various nervous system diseases. Many times, alterations in normal CSF parameters with variable and overlapping results are challenging in differential diagnosis and treatment of the diseases. The aim of the study is to know the spectrum of CSF analysis and nervous system diseases with different prevalence in our setup.Methods: Total 150 hospitalised patients with various nervous system diseases and indications were subjected to lumbar puncture and the CSF analysis was done, in a period of one year study.Results: A total of 150 patients with mean age of 50.41±19.54 years had male to female ratio of 1.63:1. CSF analysis revealed most of tuberculous meningitis (TBM) in 30(20%) patients with higher adenosine deaminase (ADA) levels of 10.7±20.24 IU/L and lymphocytic leukocytosis (81.93%). Bacterial meningitis in 8(5.3%) patients revealed highest increase in CSF mean protein levels of 349.63±226.39 mg/dL and in mean cell count of 1039.50±930.23 cells/mm3. There was significant increase in protein levels and decrease in glucose levels of CSF, both in TBM and bacterial meningitis compared to viral, fungal meningitis and other central nervous system (CNS) diseases(p<0.001).Conclusions: Spectrum of CSF analysis and CNS diseases revealed consistent findings of alteration of normal CSF variables and therefore, was found as an invaluable, rapid and cost-effective differentiating diagnostic tool.