{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:34:17Z","timestamp":1787898857185,"version":"build-2784847793"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,2,9]],"date-time":"2017-02-09T00:00:00Z","timestamp":1486598400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009210","name":"Food and Drug Administration","doi-asserted-by":"publisher","award":["RO1FD003527"],"award-info":[{"award-number":["RO1FD003527"]}],"id":[{"id":"10.13039\/100009210","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["DK066204"],"award-info":[{"award-number":["DK066204"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R21DK099716"],"award-info":[{"award-number":["R21DK099716"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01 DK091958"],"award-info":[{"award-number":["U01 DK091958"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01 DK098246"],"award-info":[{"award-number":["U01 DK098246"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the association between long\u2010term metformin therapy and serum vitamin B12 monitoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>\n                      A single Veterans Affairs Medical Center (\n                      <jats:styled-content style=\"fixed-case\">VAMC<\/jats:styled-content>\n                      ), 2002\u20132012.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Veterans 50 years or older with either type 2 diabetes and long\u2010term metformin therapy (n = 3,687) or without diabetes and no prescription for metformin (n = 13,258).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>We determined diabetes status from outpatient visits, and defined long\u2010term metformin therapy as a prescription \u2265500 mg\/d for at least six consecutive months. We estimated the proportion of participants who received a serum B12 test and used multivariable logistic regression, stratified by age, to evaluate the association between metformin use and serum B12 testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Only 37% of older adults with diabetes receiving metformin were tested for vitamin B12 status after long\u2010term metformin prescription. The mean B12 concentration was significantly lower in the metformin\u2010exposed group (439.2 pg\/\n                      <jats:styled-content style=\"fixed-case\">dL<\/jats:styled-content>\n                      ) compared to those without diabetes (522.4 pg\/\n                      <jats:styled-content style=\"fixed-case\">dL<\/jats:styled-content>\n                      ) (\n                      <jats:italic>P<\/jats:italic>\n                      = .0015). About 7% of persons with diabetes receiving metformin were vitamin B12 deficient (&lt;170 pg\/\n                      <jats:styled-content style=\"fixed-case\">dL<\/jats:styled-content>\n                      ) compared to 3% of persons without diabetes or metformin use (\n                      <jats:italic>P<\/jats:italic>\n                      = .0001). Depending on their age, metformin users were two to three times more likely not to receive vitamin B12 testing compared to those without metformin exposure, after adjusting for sex, race and ethnicity, body mass index, and number of years treated at the VAMC.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Long\u2010term metformin therapy is significantly associated with lower serum vitamin B12 concentration, yet those at risk are often not monitored for B12 deficiency. Because metformin is first line therapy for type 2 diabetes, clinical decision support should be considered to promote serum B12 monitoring among long\u2010term metformin users for timely identification of the potential need for B12 replacement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.14761","type":"journal-article","created":{"date-parts":[[2017,2,9]],"date-time":"2017-02-09T11:06:50Z","timestamp":1486638410000},"page":"1061-1066","source":"Crossref","is-referenced-by-count":40,"title":["Long\u2010term Metformin Therapy and Monitoring for Vitamin B12 Deficiency Among Older Veterans"],"prefix":"10.1111","volume":"65","author":[{"given":"Vijaya","family":"Kancherla","sequence":"first","affiliation":[{"name":"Department of Epidemiology Rollins School of Public Health Emory University Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"John L.","family":"Elliott","sequence":"additional","affiliation":[{"name":"Division of General Medicine &amp; Geriatrics Department of Medicine Emory University School of Medicine Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birju B.","family":"Patel","sequence":"additional","affiliation":[{"name":"Atlanta VA Medical Center Decatur Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. Wilson","family":"Holland","sequence":"additional","affiliation":[{"name":"Division of General Medicine &amp; Geriatrics Department of Medicine Emory University School of Medicine Atlanta Georgia"},{"name":"Atlanta VA Medical Center Decatur Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"II","given":"Theodore M.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Rollins School of Public Health Emory University Atlanta Georgia"},{"name":"Division of General Medicine &amp; Geriatrics Department of Medicine Emory University School of Medicine Atlanta Georgia"},{"name":"Atlanta VA Medical Center Decatur Georgia"},{"name":"Department of Veterans Affairs Birmingham\/Atlanta Geriatric Research, Education, and Clinical Center Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjali","family":"Khakharia","sequence":"additional","affiliation":[{"name":"Division of General Medicine &amp; Geriatrics Department of Medicine Emory University School of Medicine Atlanta Georgia"},{"name":"Atlanta VA Medical Center Decatur Georgia"},{"name":"Department of Veterans Affairs Birmingham\/Atlanta Geriatric Research, Education, and Clinical Center Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence S.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Atlanta VA Medical Center Decatur Georgia"},{"name":"Division of Endocrinology, Lipids &amp; Metabolism Department of Medicine Emory University School of Medicine Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Godfrey P.","family":"Oakley","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Rollins School of Public Health Emory University Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille P.","family":"Vaughan","sequence":"additional","affiliation":[{"name":"Division of General Medicine &amp; Geriatrics Department of Medicine Emory University School of Medicine Atlanta Georgia"},{"name":"Atlanta VA Medical Center Decatur Georgia"},{"name":"Department of Veterans Affairs Birmingham\/Atlanta Geriatric Research, Education, and Clinical Center Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,2,9]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Centers for Disease Control and Prevention.Diabetes Report Card 2014[on\u2010line]. Available athttp:\/\/www.cdc.gov\/diabetes\/pdfs\/library\/diabetesreportcard2014.pdfAccessed October 30 2016."},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.10029"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-013-2958-1"},{"key":"e_1_2_7_5_1","unstructured":"U.S. Census Beureau American Community Survey 2016[on\u2010line]. Available athttp:\/\/www.va.gov\/vetdata\/docs\/SpecialReports\/Profile_of_Veterans_2014.pdfAccessed October 30 2016."},{"key":"e_1_2_7_6_1","unstructured":"Managing Older People with Type 2 Diabetes Global Guideline 2013[on\u2010line]. Available athttp:\/\/www.idf.org\/guidelines\/managing-older-people-type-2-diabetesAccessed October 30 2016."},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-S014"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0100379"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.280.6225.1214"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2796.2003.01213.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.18.1975"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c2181"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-0606"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1R223"},{"key":"e_1_2_7_15_1","article-title":"Vitamin B12 screening in metformin\u2010treated diabetics in primary care: Were elderly patients less likely to be tested?","author":"Fogelman Y","year":"2016","journal-title":"Aging Clin Exp Res"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1998.tb04534.x"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu5114462"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2012.03998.x"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glr202"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2013.08.007"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2012.10.013"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-012-2132-3"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2008.03.011"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12514"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.56.9.1143"},{"key":"e_1_2_7_26_1","first-page":"979","article-title":"Vitamin B12 deficiency","volume":"67","author":"Oh R","year":"2003","journal-title":"Am Fam Physician"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjgs.14761","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.14761","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T19:56:12Z","timestamp":1762199772000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.14761"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,2,9]]},"references-count":25,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2017,5]]}},"alternative-id":["10.1111\/jgs.14761"],"URL":"https:\/\/doi.org\/10.1111\/jgs.14761","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,2,9]]}}}