Check B12 deficiency in all patients on metformin

Morning MEDtalks with Dr KK Aggarwal

New Delhi, December 06, 2018:

Diabetes patients taking metformin should have their vitamin B12 levels assessed regularly to avoid peripheral nerve damage. Vast majority of patients are not tested and almost 1 in 10 have vitamin B12 deficiency.

In a study of more than 150 women with diabetes presented at the Society for Endocrinology BES 2018 conference in Glasgow, the researchers showed that 64% had not been tested for vitamin B12 deficiency. Moreover, almost 10% of patients were found to have vitamin B12 deficiency.

Currently, there are no official guidelines on the screening for vitamin B12 levels in patients treated with metformin, although the British Society of Haematology recommends that levels are checked if there is a strong clinical suspicion of deficiency (Society for Endocrinology BES 2018: Abstract P092, presented 21 November. Endocrine Abstracts (2018) 59 P092)

FDA takes new action to advance the development of reliable and beneficial genetic tests that scan a person’s DNA to diagnose genetic diseases and guide medical treatments. For the first time, the agency has formally recognized a public database that contains information about genes, genetic variants and their relationship to disease. The FDA is recognizing the genetic variant information in the Clinical Genome Resource (ClinGen) consortium’s ClinGen Expert Curated Human Genetic Data, which is funded by the National Institutes of Health (NIH), as a source of valid scientific evidence that can be used to support clinical validity in premarket submissions. This recognition by the FDA will facilitate test developers, including those that use a technology known as next generation sequencing, to rely on the information available in the database to support the validity of their tests, instead of having to generate the information on their own.

Five critical steps needed to get nutrition on track (Global Nutrition Report 2018)

1. Break down silos between malnutrition in all its forms. Different forms coexist and need integrated approaches. All stakeholders must take a more holistic view of malnutrition. The data shows that all stakeholders, governments, donors and nutrition and non-nutrition communities need to shift mindsets and embrace the need to address the full range of nutritional problems in local and national contexts if we are to meet the 2030 target of ending malnutrition in all its forms.
2. Prioritise and invest in the data needed and capacity to use it. Designing actions that result in impact is impossible without adequate knowledge of who is affected by malnutrition and why. Without good data, we’re just guessing
3. Scale up financing for nutrition – diversify and innovate to build on past progress. Ultimately we cannot make progress without adequate funds, and those who control resource flows need to prioritise nutrition. Funding needs to be focused on ensuring nutrition plans are delivered in practice.
4. Galvanise action on healthy diets – engage across countries to address this universal problem. The poor quality of diets among infants, young children, adolescents and adults is unacceptable. With malnutrition having such a universal and devastating impact, there is a role for all sectors in improving the quality of the world’s diets.
5. Make and deliver better commitments to end malnutrition in all its forms – an ambitious, transformative approach will be required to meet global nutrition targets. Concerted efforts to tackle malnutrition will only continue if signatories consistently deliver against SMART (specific, measurable, achievable, relevant and time-bound) commitments.

UN agriculture chief urges ‘transformative changes’ to how we eat: Obesity affects millions of people, and several billion suffer from diseases caused by vitamin- or mineral-deficient diets, known as micronutrient deficiencies, according to the UN agriculture chief, who called on Monday for “transformative changes” to our food systems. “The coexistence of undernutrition, obesity and micronutrient deficiencies – what we know as the triple burden of malnutrition – is spreading and affecting almost every country in the world”, José Graziano da Silva, Director-General of the Food and Agriculture Organization (FAO) said in his opening address to the agency’s executive body, the FAO Council. “The international community needs to urgently address this situation by promoting transformative change in our food systems,” he continued. “Our Zero Hunger Goal is not just about feeding people”, but also “providing everyone with the necessary nutrients for a healthy life.” (UN, Dec. 3, 2018).

First baby born after deceased womb transplant: A healthy baby girl has been born using a womb transplanted from a dead body. The 10-hour transplant operation – and later fertility treatment – took place in São Paolo, Brazil, in 2016. The mother, 32, was born without a womb. There have been 39 womb transplants using a live donor, including mothers donating their womb to their daughter, resulting in 11 babies. But the 10 previous transplants from a dead donor have failed or resulted in miscarriage. In this case, the womb donor was a mother of three in her mid-40s who died from bleeding on the brain. The recipient had Mayer-Rokitansky-Küster-Hauser syndrome, which affects about one in every 4,500 women and results in the vagina and uterus (womb) failing to form properly. But the ovaries were fine … (BBC)

Prebiotics, probiotics, synbiotics and antibiotics in IBS: A systematic review and meta-analysis examining the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome (IBS) concluded that it is still unclear, for the most part, as to which particular combination, species or strains of probiotics are effective for IBS. Rifaximin has modest efficacy in improving symptoms in non-constipated IBS (Alimentary Pharmacology & Therapeutics, Nov. 2018).

Is your patient on statin complaining of gynecomastia? A recent meta-analysis published in the journal Clinical endocrinology has found that statins decrease circulating testosterone levels in men.

A cohort of patients from a random sample of 9 053 240 US subjects from the PharMetrics Plus™ health claims database from 2006 to 2016 was created. New cases of gynecomastia requiring at least two ICD-9 codes were identified from the cohort and matched to 10 controls by follow-up time and age using density-based sampling. Rate ratios (RRs) for users of statins were computed using conditional logistic regression adjusting for alcoholic cirrhosis, hyperthyroidism, testicular cancer, Klinefelter syndrome, obesity, hypogonadism, hyperprolactinemia and use of spironolactone, ketoconazole, H2 receptor antagonists (H2blockers), risperidone, testosterone and androgen deprivation therapy. Our cohort included 6147 cases of gynecomastia and 61 470 corresponding matched controls. The adjusted RR for current, recent and past statin use with respect to gynecomastia was 1.19 (1.04–1.36), 1.38 (1.15–1.65) and 1.20 (1.03–1.40), respectively. The study concluded that statin use is associated with an increased risk of developing gynecomastia. Clinicians should be cognizant of this effect and educate patients accordingly.

Video to watch: TEDx Video: Doctor-patient relationship www.youtube(dot)com/ watch?v=i9ml1vKK2DQ

Dr KK Aggarwal
Padma Shri Awardee
President Elect CMAAO
President Heart Care Foundation of India