Improving Vitamin B12 Monitoring in Metformin-Treated Patients: A Quality Improvement Project

Background: Although periodic vitamin B12 monitoring is recommended for patients on chronic metformin therapy, the recommendation is not adequately followed. Similar quality improvement project in the past had failed due to ongoing COVID-19 pandemic. Objectives: The main objective of this study is to evaluate the impact of focused educational lectures on vitamin B12 screening rates. Our target study population included diabetics and prediabetics on chronic metformin therapy. Design: Quality improvement pre-post design Participants: Internal Medicine residents Intervention: Educational sessions on the importance of vitamin B12 screening in this population Outcomes: Proportion of patients undergoing vitamin B12 screening pre and post-intervention Results: There was a statistically significant increase in vitamin B12 screening after the teaching intervention from 43.3% to 55% with χ2 (1, N=264) = 3.91, p =0.047. Linear regression analysis was conducted to determine the effects of sex, age, race, years of metformin use, chronic kidney disease, chronic liver disease, proton pump inhibitor use, type 2 histaminic blocker use, colchicine use, and alcohol consumption on vitamin B12 levels. No significant relationship was found between any of the variables. Conclusion: Focused simple educational efforts can lead to a positive impact in patient care and clinical practice.