Effect of a combination of gliptin and metformin on serum vitamin B12, folic acid, and ferritin levels

Genc, Fevziye Turkoglu; Nalbant, Ahmet; Genc, Ahmed Cihad; Kaya, Tezcan

doi:10.1590/1806-9282.20230641

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 69 (11) • 2023 • https://doi.org/10.1590/1806-9282.20230641 copy

Effect of a combination of gliptin and metformin on serum vitamin B12, folic acid, and ferritin levels

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The primary objective of this study was to explore the impact of metformin and metformin/gliptin combination therapy on the serum concentrations of vitamin B12, ferritin, and folic acid in individuals diagnosed with type 2 diabetes.

METHODS:

This study included 118 patients, classified into two groups: 59 patients using only metformin and 59 patients using a combination of metformin/gliptin. Among the latter group, 35 patients used vildagliptin/metformin, and 24 used sitagliptin/metformin. The study recorded the demographic data such as the age and gender of the patients, as well as their initial and 1-year follow-up blood parameters.

RESULTS:

Folic acid decreased significantly in the metformin group but not in the metformin/gliptin group. Vitamin B12 and ferritin decreased significantly in both groups. The decrease in vitamin B12 and ferritin was not significantly different between the two groups. The decrease in fasting plasma glucose was more significant in the metformin/gliptin group than in the metformin group.

CONCLUSION:

After 1 year, both groups taking metformin and metformin/gliptin showed low serum ferritin and vitamin B12 levels. Therefore, vitamin B12 levels in patients using these drugs should be closely monitored. Ferritin levels can be used to indicate whether glycemic control has been achieved.

KEYWORDS:
Diabetes mellitus; Metformin; Folic acid; Gliptin; Ferritin; Vitamin B12

Variables		Metformin, n=59	Metformin/gliptin, n=59	Total, n=118	p-value
Age, years		52 [17]	58 [11]	55 [14]	0.022
Gender					0.001*
	Female, n (%)	39 (66.1%)	20 (33.9%)	59 (50%)
	Male, n (%)	20 (33.9%)	39 (66.1%)	59 (50%)
Fasting plasma glucose (FPG), mg/dL		131 [27]	183 [84]	146 [80]	<0.001
eGFR		99 [21]	100.7 [14.6]	100 [19]	0.651
Triglyceride, mg/dL		152 [127.5]	140 [97.5]	144 [109]	0.481
Total cholesterol, mg/dL		215 [37]	208.5 [53]	212.5 [43]	0.380
HDL, mg/dL		48 [14]	41.5 [12]	43.5 [15]	0.005
LDL, mg/dL		142 [44]	133.5 [36]	139.5 [38.5]	0.318
HbA1c, %		6.5 [1.3]	8.6 [2.4]	7.4 [2.8]	0.001
Vitamin B12, ng/L		275 [178]	309 [218]	302 [197]	0.122
Ferritin, μg/L		46 [83]	83 [121.4]	60 [94]	0.020
Folic acid, μg/L		8.9 [4.8]	6.9 [3.2]	7.95 [3.2]	0.001

Variables	Metformin		p-value	Metformin/gliptin		p-value
	n=59	n=59		n=59	n=59
	Beginning	1 year later		Beginning	1 year later
Fasting plasma glucose (FPG), mg/dL	131 [27]	116 [30]	0.001	183 [84]	143 [57]	<0.001
eGFR	99 [21]	104 [24]	0.737	100.7 [16.1]	102.3 [11.05]	0.208
Triglyceride, mg/dL	152 [132.75]	160.5 [118.5]	0.467	140 [98.25]	144 [119]	0.486
Total cholesterol, mg/dL	215 [37.5]	205 [52]	0.564	208.5 [55]	210.5 [76]	0.866
HDL, mg/dL	48 [14.175]	46.5 [17.75]	0.658	41.5 [12.25]	42 [12]	0.611
LDL, mg/dL	142 [44.75]	136 [47.5]	0.362	133.5 [36.75]	138 [61]	0.721
HbA1c, %	6.5 [1.3]	6.4 [1.3]	0.112	8.6 [2.4]	7.3 [1.2]	0.001
Vitamin B12, ng/L	275 [178]	232 [151]	0.001	309 [218]	260 [160]	0.001
Ferritin, μg/L	46 [83]	38 [60.3]	0.001	83 [121.4]	66.2 [99]	0.002
Folic acid, μg/L	8.9 [4.8]	8.1 [5.1]	0.001	6.9 [3.2]	6.4 [3.4]	0.346

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[1] *Corresponding author: fevziyeturkoglu@gmail.com