Development and validation of a survey on attitudes and clinical practice of health professionals in relation to vitamin B12 deficiency and metformin use in patients with diabetes mellitus in Argentina

Abstract

Introduction: the relationship between the use of metformin and low levels of vitamin B12 has been widely studied, however, there is no information on the knowledge of this association and clinical practice in Argentina.

Objectives: the objective of this study was to develop and validate a survey to assess the perception and clinical practice of physicians regarding vitamin B12 deficiency in patients with diabetes mellitus treated with metformin.

Material an methods: a cross-sectional study was conducted using a survey distributed through the Argentinean Diabetes Society to evaluate the knowledge, attitudes, and clinical practices related to the assessment and management of vitamin B12 deficiency in diabetic patients receiving metformin treatment. The survey was distributed to physicians via email and WhatsApp, and participants were encouraged to respond based on their usual practice. The survey included demographic questions, perception of risk factors, and questions related to diagnostic and therapeutic approaches.

Results: a total of 345 physicians completed the survey. Most of participants were female (73%) and specialized in diabetes (52.6%). The validation of the instrument, its adequate viability should be noted (with a 90th percentile of the questionnaire resolution time of less than 5 minutes). The internal consistency of the questionnaire was also appropriate with standardized Cronbach's alpha coefficients greater than 0.70, relatively little affected by the exclusion of questions from the model. The perception of risk factors showed that physicians considered restriction of animal-origin foods (84.3%) and malabsorption (91.8%) as important risk factors for vitamin B12 deficiency. However, there was a discrepancy in the perception regarding the restriction of plant-origin foods (73.6%) and the association with vitamin B12 deficiency. Similarly, there appears to be a perception of risk in adolescents with no perception of risk in the elderly in a group of participants. The analysis of clinical practice revealed that most physicians (80.3%) requested vitamin B12 markers for their patients with diabetes, and a significant proportion (69.9%) requested them specifically for patients receiving metformin for more than 5 years and 1700 mg/day of dosing. Participants confirmed that the analysis is requested once a year in 62% and most of them (84.9%) diagnosed and treat vitamin B12 deficiency.

Conclusions: the evaluated questionnaire resulted viable, with a good internal consistency. Our study also highlights the high awareness among physicians regarding the risk of vitamin B12 deficiency in patients with diabetes receiving metformin. However, there were discrepancies in the perception of some risk factors, particularly regarding plant-origin food restriction and adolescents. Although most physicians assessed the levels of vitamin B12 in their patients, there is room for improvement in the regularity of assessment and adherence to guidelines. These findings emphasize the importance of continuous medical education to ensure appropriate management of vitamin B12 deficiency in patients with diabetes receiving metformin.