VITAMIN B12 AND HOMOCYSTEINE IN METFORMIN-TREATED DIABETIC PATIENTS: A LITERATURE REVIEW

This review comprehensively examines the intricate relationship between chronic metformin therapy, vitamin B12 deficiency, and elevated homocysteine levels in patients with diabetes mellitus. Specifically, it delves into the physiological mechanisms underlying these interactions and their clinical implications for patient management and long-term health outcomes. The review further explores how vitamin B12 deficiency, often exacerbated by metformin use, contributes to hyperhomocysteinemia, a known risk factor for cardiovascular complications in diabetic individuals (Auer et al., 2001). The precise mechanisms by which metformin influences vitamin B12 absorption and metabolism will be elucidated, alongside the biochemical pathways linking B12 deficiency to the accumulation of homocysteine and methylmalonic acid (Sabeen & Holroyd, 2009). Furthermore, the clinical manifestations of these deficiencies, ranging from neurological impairments to hematological abnormalities, will be thoroughly discussed, emphasizing the need for proactive monitoring and supplementation strategies. This synthesis of current literature aims to provide a robust foundation for understanding these complex interdependencies, ultimately informing improved clinical guidelines and patient care protocols. This review also critically assesses the current evidence regarding the efficacy of vitamin B12 supplementation in mitigating these adverse effects, considering dosage, route of administration, and patient-specific factors. It also explores the potential for personalized medicine approaches in managing vitamin B12 status in this patient population, considering genetic predispositions and individual metabolic variations.