Metformin use in patients with type 2 diabetes mellitus and chronic kidney
disease: An evidence-based review

Tan, Felicia Clara Jun Hui; Ang, Seng Bin; Bee, Yong Mong

doi:10.47102/annals-acadmedsg.2020464

Cited by 2 publications

(2 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Metformin is excreted renally and its use is contraindicated in advanced chronic kidney disease (CKD) [ 48 ]. CKD is in turn associated with physiological age-related decline in kidney function and the duration of T2DM [ 49 ] (See Supplementary file ).…”

Section: Discussionmentioning

confidence: 99%

Determinants of vitamin B12 deficiency in patients with type-2 diabetes mellitus — A primary-care retrospective cohort study

Wee

Sultana

2023

BMC Prim. Care

View full text Add to dashboard Cite

Background Like many developed nations, the prevalence of both older people and type-2 diabetes mellitus (T2DM) in Singapore is rising. This demographic shift predisposes the population to greater risks of both frailty and its complications that can be further aggravated by vitamin B12 deficiency —a highly prevalent associated variable that is potentially modifiable. Indeed, B12 deficiency adversely impacts the neuro-cognitive, haematological, and even the immune systems; jeopardizing our aspirations for successful aging. Despite this, many patients with T2DM in primary care remain unscreened due to a lack of clear guidelines for regular B12 screening. We therefore investigated the determinants of B12 deficiency in community-dwelling patients with T2DM, with the aim of profiling patients most in need of B12-deficiency screening. Methods B12 deficiency was evaluated using a retrospective cross-sectional cohort of 592 primary-care patients with T2DM, recruited from 2008 to 2011 from a Polyclinic in Singapore. Results B12 deficiency (serum B12 < 150 pmol/L) was present in 164 (27.7%) patients and was associated with a higher “metformin daily dose” (OR = 2.79; 95% CI, 2.22–3.48, P < 0.001); “age ≥ 80 years” (OR = 2.86; 95% CI, 1.31–6.25, P = 0.008); “vegetarianism” (OR = 21.61; 95% CI, 4.47–104.44, P < 0.001); and “folate deficiency” (OR = 2.04; 95% CI, 1.27–3.28, P = 0.003). Conversely, “Prescribed B12 supplementation” was associated with a lower odds of B12 deficiency (OR = 0.37; 95% CI: 0.22–0.61, P < 0.001). The area under the receiver operating characteristic curve was 0.803 (95% CI: 0.765–0.842). “Metformin daily dose” correlated interchangeably with “Metformin 1-year cumulative dose” (r = 0.960; P < 0.01), and also associated linearly with “duration of diabetes” (B = 0.113, P < 0.0001). Independent of the duration of T2DM, 29.3% of the B12-deficient patients needed > 1 screening test before the detection of B12 deficiency. Conclusions Primary-care screening for B12 deficiency should be part of the annual laboratory review of patients with T2DM regardless of the duration of T2DM —especially when they are prescribed ≥ 1.5 g/day of metformin; ≥ 80 years old; vegetarian; and not prescribed B12 supplementation. Concurrent evaluation for associated folate (vitamin B9) deficiency is essential when addressing T2DM-associated B12 deficiencies. Current “Metformin daily dose” is an accurate proxy of both cumulative metformin exposure and duration of T2DM.

show abstract

Section: Discussionmentioning

confidence: 99%

Determinants of vitamin B12 deficiency in patients with type-2 diabetes mellitus — A primary-care retrospective cohort study

Wee

Sultana

2023

BMC Prim. Care

View full text Add to dashboard Cite

show abstract

“…The persistent high glucose levels result in oxidative stress, in ammation, and cellular damage across various tissues. These adverse effects impair both beta-cell function and insulin sensitivity, creating a vicious cycle that exacerbates insulin resistance and beta-cell dysfunction [11,89,90].…”

Section: Stressmentioning

confidence: 99%

Environmental and Lifestyle Determinants of Type 2 Diabetes Mellitus

Siddiqui,

Baig,

Khan

2024

Preprint

View full text Add to dashboard Cite

Objective: This study aims to comprehensively investigate the role of various environmental and lifestyle factors—including obesity, diet, physical inactivity, urbanization, socioeconomic status, sleep patterns, stress, environmental pollutants, gut microbiota, smoking, and alcohol consumption—in the pathogenesis of Type 2 diabetes mellitus (T2DM). Background: Type 2 diabetes mellitus (T2DM) is a global health challenge influenced by genetics, environment, and lifestyle. Key factors affecting T2DM include obesity, unhealthy diet, physical inactivity, urbanization, socioeconomic status, sleep patterns, stress, environmental pollutants, gut microbiota, smoking, and alcohol consumption. Understanding these factors' roles in insulin resistance, beta-cell dysfunction, glucotoxicity, lipotoxicity, and inflammation is crucial for effective prevention and management. Methods: A comprehensive search of databases such as PubMed, MEDLINE, Google Scholar, and various journals was conducted without date restrictions. The studies were systematically reviewed to explore the mechanistic links between environmental factors and T2DM pathophysiology. The study adhered to PRISMA guidelines. Results: The study revealed diverse associations between environmental and lifestyle factors and T2DM pathogenesis. Obesity was identified as a central contributor, promoting insulin resistance and adipose tissue dysfunction. Unhealthy diets increased T2DM risk through glucotoxicity and lipotoxicity. Sedentary behavior and urbanization compounded these effects. Socioeconomic disparities influenced T2DM prevalence, with lower SES individuals at higher risk. Sleep patterns, stress, environmental pollutants, and gut microbiota composition significantly affected T2DM development. Smoking and alcohol consumption were linked to increased insulin resistance and beta-cell dysfunction. These findings highlight the multifactorial nature of T2DM and the importance of addressing diverse environmental and lifestyle factors for effective prevention and management strategies. Conclusion: Obesity, diet, physical inactivity, urbanization, socioeconomic status, sleep patterns, stress, environmental pollutants, gut microbiota, smoking, and alcohol consumption collectively influence insulin resistance, beta-cell dysfunction, glucotoxicity, lipotoxicity, and inflammation in T2DM. Addressing these factors is essential for prevention and management. Promoting healthy lifestyles, improving healthcare access, and mitigating environmental exposures can reduce risk and improve outcomes. Understanding the interplay of these factors provides insights into T2DM's complex nature and informs comprehensive strategies for its prevention and treatment.

show abstract

Metformin use in patients with type 2 diabetes mellitus and chronic kidney disease: An evidence-based review

Cited by 2 publications

References 32 publications

Determinants of vitamin B12 deficiency in patients with type-2 diabetes mellitus — A primary-care retrospective cohort study

Determinants of vitamin B12 deficiency in patients with type-2 diabetes mellitus — A primary-care retrospective cohort study

Environmental and Lifestyle Determinants of Type 2 Diabetes Mellitus

Contact Info

Product

Resources

About