{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T12:09:10Z","timestamp":1785326950362,"version":"3.55.0"},"reference-count":31,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T00:00:00Z","timestamp":1693785600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T00:00:00Z","timestamp":1693785600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1042231"],"award-info":[{"award-number":["1042231"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["513781"],"award-info":[{"award-number":["513781"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>There are limited data relating to the effects of metformin\u2010associated vitamin B12 deficiency on the risk of distal symmetrical polyneuropathy (DSPN) and megaloblastic anaemia in well\u2010characterised community\u2010based cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To assess inter\u2010relationships between metformin therapy, vitamin B12 deficiency assessed using serum active B12 concentrations, and DSPN and anaemia in 1492 Fremantle Diabetes Study Phase 2 (FDS2) participants with type 2 diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prevalence rates of vitamin B12 deficiency (total &lt;80 pmol\/L, active &lt;23 pmol\/L) and borderline deficiency (total \u226580 and \u2264200 pmol\/L, active \u226523 and \u226435 pmol\/L) were determined using baseline sera. The relationship between vitamin B12 status and both DSPN and anaemia was assessed using multivariable analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Most FDS2 participants (94.4%) were vitamin B12 replete (total serum concentration &gt;200 pmol\/L, active &gt;35 pmol\/L), 2.0% were deficient (total &lt;80 pmol\/L, active &lt;23 pmol\/L) and the remainder (3.6%) borderline. Although metformin treatment increased the odds of deficiency (4.2%, 3.1% borderline) in a dose\u2010dependent fashion (odds ratio (95% confidence interval) 39.4 (4.90\u2013316) for &gt;2000 mg daily compared with no treatment;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;\u20090.001), there was no significant association between vitamin B12 status and DSPN, anaemia (haemoglobin \u2264130 g\/L males, \u2264120 g\/L females), haemoglobin concentration or mean corpuscular volume (\n                      <jats:italic>P<\/jats:italic>\n                      \u2265\u20090.147). Metformin increased the likelihood of anaemia, especially at high doses, independent of vitamin B12 deficiency.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Since nutritional sources likely attenuate metformin\u2010associated vitamin B12 malabsorption and its clinical sequelae in developed countries such as Australia, there is no need for routine\/opportunistic serum vitamin B12 screening in metformin\u2010treated patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/imj.16225","type":"journal-article","created":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T13:29:40Z","timestamp":1693834180000},"page":"575-581","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Serum vitamin\n                    <scp>B12<\/scp>\n                    , distal symmetrical polyneuropathy and anaemia in type 2 diabetes: the Fremantle Diabetes Study Phase 2"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0749-7411","authenticated-orcid":false,"given":"Timothy M. 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