الفهرس 
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Abstract
Type 2 Diabetes Mellitus (T2DM) is associated with a range of systemic microvascular and macrovascular complications, being the most common is diabetic neuropathy. Other types of neuropathies may be encountered and are treatable if it is early detected; like that induced by vitamin B12 deficiency.
Metformin is considered the first line therapy for treatment of T2DM. Malabsorption of vitamin B12 is one of reported side effects of Metformin use. So, many studies worldwide investigated its effect on vitamin B12 and the effect of metformin-induced vitamin B12 deficiency on the frequency or severity of diabetic peripheral Neuropathy.
Objectives:
To determine the association between the level of vitamin B12 and clinical peripheral Neuropathy score among T2DM patients who are on metformin in comparison to those who are not taking it.
Subjects and methods:
A comparative descriptive study conducted in outpatient clinics of Ain shams University and recruited 100 type 2 diabetic patients who were divided into 2 groups; metformin treated, and non-metformin treated (50 subjects per group).
The collected data included personal history, medical history, dietetic history that included frequency of eating food rich in vitamin B12 and clinical Peripheral Neuropathy assessment by Toronto Clinical Scoring System (TCSS). Blood samples were collected for assessment of HbA1c and vitamin B12 level.
Results:
Vitamin B12 deficiency was present in 4% of metformin group and 2% of non- metformin group. The mean value of vitamin B12 was lower in metformin users than non- metformin users (624.3 ±364.1 pg/ml and 991.0 ±489.9 pg/ml respectively) with a high significant difference, p= 0.023. There was a significant difference between study groups regarding HbA1c level (p value= 0.03). Peripheral Neuropathy was significantly associated with HbA1c (p value= 0.04) and female gender (p value= 0.001).
Recommendations:
• Screening of vitamin B12 level in patients on metformin.
• Diabetic patients with peripheral neuropathy should be checked for glycemic control.
• Family Medicine physicians should make sure that patients do routine diabetes investigations regularly. In addition to annual screening for diabetic neuropathy to prevent the risk of diabetic foot.