台灣某地區教學醫院使用Metformin糖尿病人飲食與血清維生素B_(12)之探討

The Descriptive Study of Dietary and Serum Vitamin B_(12) Among Subjects with type 2 Diabetes on Metformin Therapy in a Regional Teaching Hospital in Middle Taiwan

林芷瑄(Chih-Hsuan Lin1) ； 張文彬(Wen-Pin Chang3) ； 戴德炎(Der-Yan Tai) ； 楊淑惠(Shwu-Huey Yang)

《內科學誌》 26卷6期 (2015/12) Pp. 344-352

https://doi.org/10.6314/JIMT.2015.26(6).06

摘要

二甲雙胍類藥物(Metformin)經常是治療糖尿病的第一線口服降血糖藥物，然而自1971年起即有研究指出Metformin會導致降低維生素B_(12)的吸收及造成血清維生素B_(12)值降低，但是此些研究都沒有提供飲食維生素B_(12)的資料。維生素B_(12)是人體所不可或缺的營養素之一，它對於人體細胞之生長、紅血球之形成及上皮(epithelium)細胞更新及神經髓鞘質(myelin)之維持扮演著非常重要的角色。因此本研究目的為探討台灣地區糖尿病病人在飲食維生素B_(12)攝取狀況及是否因長期服用Metformin 藥物而造成血清中維生素B_(12)缺乏。研究以台灣某中部區域級教學醫院新陳代謝科年齡20-85歲之第2型糖尿病病人為主，排除全素者、胃切除者及每週大於3天以上固定服用營養補充劑者。本研究為回溯性研究，共計收集200位使用口 服降血糖藥受試者，其中190位有使用Metformin、10位非使用Metformin口服降血糖藥。測量體位、收集血液及以24小時回憶與飲食頻率問卷收集飲食資料，分析飲食維生素B_(12)攝取 量及血清維生素B_(12)值是否有受到使用Metformin的影響。結果得受試者的飲食中維生素B_(12)攝取量足夠，且使用Metformin並未顯著降低血清維生素B_(12)值。

關鍵字

糖尿病 ； 口服降血糖藥 ； 二甲雙胍類藥物 ； 維生素B_(12)

並列摘要

Metformin has been considered the first choice of oral antidiabetic drugs (OADs) for type 2 diabetes mellitus (T2DM) patients. It has been proposed that Metformin could reduce vitamin B_(12) absorption since 1971. Vitamin B_(12) is one of the essential nutrients for body and human cells growth, red blood cells formation and maintains epithelium and neuron myelin function. The symptoms of vitamin B_(12) deficiency include precious anemia and nervous system disorders, such as neuropathy, spinal cord lesions, and memory disorders. We observed whether Metformin treatment for T2DM patients with adequate vitamin B_(12) intake may cause serum vitamin B_(12) deficiency or not. This was a cross-sectional study and recruited T2DM subjects aged from 20-85 yrs., excluded patients of vegetarians, postgastrotomy, and taking vitamin supplements more than thrice a week regularly. We collected medical history and blood data, dietary information by 24 hours dietary recalls and food frequency questionnaire (FFQ). Total 200 subjects were recruited in this study, vitamin B_(12) intake was 1.8 ± 1.7 μg/day by 24- hour dietary recalls, 3.7 ± 2.6 μg/day by FFQ, serum vitamin B_(12) levels was 493.6 ± 318.3 pg/ml. There were strong correlations between 24 hours and FFQ (p ＜ 0.000) in vitamin B_(12) intake, but no correlation between dietary vitamin B_(12) and serum vitamin B_(12) (p ＞ 0.05). No significant correlation existed among Metformin dosage and dietary vitamin B_(12), blood vitamin B12 level. No serum vitamin B_(12) deficiency existed when Metformin treatment for T2DM patients with adequate vitamin B_(12) intake in a Taiwan regional teaching hospital.

並列關鍵字

Diabetes mellitus ； Oral antidiabetic drugs ； Metformin ； Vitamin B_(12)