Metformin – Is This First Line Medicine Safe?

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This is the substance of an articlepublished in the April issue of Diabetes Care. The title they use is“Diabetes Prevention With Metformin Is Safe, Well-Tolerated.” In essence this is correct, but only when other vitalinformation is added which is absent from the details of this study. A pharmacist friend very kindly pointed this out to me in an email.
She stated, “Metformin can for many(but not all) individuals cause a Vitamin B12 deficiency. Unless theyconsume foods high in Vitamin B12, most people will end up havingthis deficiency in long-term Metformin use.” Even my ownendocrinologist suggested adding a Vitamin B12 supplement to myregimen while on Metformin. I am thankful I listened to her. I wasnot Vitamin B12 deficient, but I was at the low point in therecommended range.
Based on my experience, I would suggestanyone taking Metformin (glucophage) talk with their doctor abouthaving the Vitamin B12 test done to establish a baseline and adiscussion about adding Vitamin B12 at some point. I repeat, thisshould include anyone taking or adding metformin to their medicationregimen. This is one area that I now feel strongly enough about torepeatedly urge people taking metformin to have the vitamin B12 testdone. 
A little background into the symptomsof vitamin B12 deficiency shows they are the classic fatigue andanemia. Most doctors will not do this test, “because the 'Standardof Care' is to ONLY do Vitamin B12 Testing if a patienthas a condition called Macrocytic Anemia- where red blood cellsbecome large and shows up as a high number on the MCV Blood Test thatis part of a Complete Blood Count. This is somewhat arbitrary andstops many tests that could prevent severe vitamin B12 deficiency.
This article from WebMD dated June 8,2009 is the article my pharmacist friend suggested that I read. Yes,it is a very convincing argument for being screened for vitamin B12deficiency. In the study, 40 percent of type 2 diabetes patientsusing metformin had vitamin B12 deficiency or were in the low-normalrange for vitamin B12. Of 77 percent of metformin users with vitaminB12 deficiency also had peripheral neuropathy. This is a commonnerve damage complication associated with type 2 diabetes.
Peripheral neuropathy is a majorcomplication of diabetes, as such, the researchers suggest thatpeople using metformin be screened for vitamin B12 deficiency orsupplemented with vitamin B12. They further stated that anyonealready diagnosed with peripheral neuropathy that uses metforminshould be screened for vitamin B12 deficiency.