In summary, health benefits and improved quality of life are realized when patients being treated for chronic conditions are monitored closely. With the direct correlation between metformin use and potential consequences established, the frequency and extent of vitamin B12 screening needs to be addressed.5

Substantial support exists for monitoring at-risk patients, especially those presenting with complaints of neuropathy. It is important to educate providers and patients of this risk, monitor for symptoms of neuropathy, assess vitamin B12 levels when deemed appropriate, and consider prophylaxis when metformin is initially prescribed to thwart the development of symptoms.

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Implementation of a simple routine laboratory screening test in conjunction with oral or injectable supplementation of vitamin B12 would reduce the risk for metformin-induced vitamin B12 deficiency. Such shifts in the treatment paradigm would allow patients to follow a continuum of health and minimize the deleterious effects of T2DM, such as physical inactivity because of peripheral neuropathy, weight gain, depression, and poor glucose control. Proactively addressing the risk of developing low vitamin B12 levels in this patient population not only reduces potential physical and mental sequelae but also lessens the financial burden of disease, appointments, testing, loss of time from work, and reduction in wages. Efficient patient care, coupled with prudent expenditure of healthcare dollars, benefits all stakeholders, and screening and supplementation of vitamin B12 in this patient population is one example of such care.

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Paula Peacock, ARNP, FNP-BC, MSN, is a nurse practitioner at Baptist Health, in Jacksonville, Florida.


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