الفهرس 
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Abstract
Hypofunction could be caused by a decrease in intrinsic factor levels, changes in small intestine motility leading to increased bacterial proliferation, or reduced calcium-dependent absorption in the gastrointestinal tract. Researchers have found that vitamin B12 deficiency caused by metformin increases the risk of peripheral neuropathy and makes it worse in those with type 2 diabetes (T2D). Vitamin B12 insufficiency in type 2 diabetics can be evaluated using metabolic urine index (MUI), a risk assessment tool. The exact values of the Malnutrition Universal Screening Tool (MUIS) in people with adequate nutritional statuses need more research.
The purpose of this research is to examine the correlation between vitamin B12 insufficiency and renal function in older persons on metformin.
The outpatient clinic of the Department of Internal Medicine at Minia University hospital recruited 100 patients with type 2 diabetes mellitus for this prospective observational study. from August 2022 to November 2023, the research was carried out. Seventy people who were given metformin as a prescription and thirty people who were not given metformin (acting as a control group) made up the two groups of participants. The glomerular filtration rate (GFR) was used to separate the metformin group into three subgroups. Half of the original group had a glomerular filtration rate (GFR) greater than 90 ml/min/1.73m. Twenty people with glomerular filtration rates (GFRs) between sixty and ninety ml/min/1.73 m make up the second group. Twenty people fall into the third category, representing those with glomerular filtration rates (GFR) between forty-five and sixty ml/min/1.73 m.
Study participants’ ages, sexes, diabetes durations in years, body mass indexes (kg/m2), and BMI categories did not differ significantly from one another (p value >0.05), according to the study’s primary conclusions.
2. When it comes to diabetic peripheral neuropathy, the groups that are being studied are significantly different from one another. To be more precise, DPN affected 38% of metformin users but just 16.7% of people who did not take the medication.
The levels of vitamin B12 differ significantly among the research groups (p value<0.05). In comparison to those who did not take metformin (330), those who did so had a substantially lower mean vitamin B12 level (250).
4. Vitamin B12 deficiency was more common among metformin users (31% vs. 16.5%) than among non-metformin users (16.5%).
5. The levels of vitamin B12 differ significantly among the various kinds of MUI, as indicated by a p-value that is less than 0.05.
6. Vitamin B12 deficiency was most common in those whose MUI was more than 15 (90%) and least common in those whose MUI was less than 5 (4%).
7. In regards to creatinine level, there is a statistically significant difference between the groups that were tested (p value<0.05).
8. Among the groups that were tested, there is no discernible difference in FBG, HBA1C, CA, TSH, and HB (p value > 0.05).
9. The glomerular filtration rate (GFR) differs significantly among the examined groups, as shown by a p-value lower than 0.05.As a whole, the glomerular filtration rate (GFR) of patients who did not take metformin was greater than 90, whereas among those who did, 43% had a normal GFR, 28.5% had a GFR between 60 and 90, and the same percentage had a GFR below 60.
10. When considering vitamin B12, there is a statistically significant variation among the different GFR groups (p value<0.05).
11. Vitamin B12 insufficiency was most common (65%) in people whose glomerular filtration rate (GFR) was less than 60. Those whose GFR was greater than 90 had the lowest prevalence, at 10%.
Twelve, vitamin B12 levels are significantly inversely related to age (r = -0.47, p < 0.001), MUI (r = -0.65, p < 0.001), body mass index (r = -0.41, p < 0.001), creatinine levels (r = -0.42, p < 0.001), and length of time with type 2 diabetes mellitus (r = -0.54, p < 0.001).
The correlation between vitamin B12 and GFR is quite substantial (r=0.51, p value <0.001).
Calcium (Ca) and hemoglobin (HB), fasting blood glucose (FBG), and glycated hemoglobin (HBA1C) were not noticed to be related. Group, MUI, BMI, and age were the only four variables that maintained statistical significance in the multivariable model once additional features that suggest a possibility of vitamin B12 insufficiency were taken into consideration.
15. When looking at sex differences, it is worth noting that males are more likely to experience vitamin B12 insufficiency than females (OR=1.3), but this difference is not statistically significant (p>0.05).
16. When looking at groups, the results show that patients on metformin were 3.6 times more likely to have vitamin B12 insufficiency than those not taking metformin (OR=3.6), and this difference was statistically significant (p<0.05).
17. Patients with a glomerular filtration rate (GFR) < 60 were more likely to have vitamin B12 insufficiency than those with a normal GFR. With a p-value lower than 0.05 and an odds ratio (OR) of 8.5, this risk was statistically significant.
18. There is a statistically significant correlation between an increase in MUI and a vitamin B12 deficit; the odds ratio (OR) is 3.6, and the p-value is less than 0.05.