RESUMEN
Background/Objectives: Vitamin B12 deficiency can cause variable symptoms, which may be irreversible if not diagnosed and treated in a timely manner. We aimed to develop a widely accepted expert consensus to guide the practice of diagnosing and treating B12 deficiency. Methods: We conducted a scoping review of the literature published in PubMed since January 2003. Data were used to design a two-round Delphi survey to study the level of consensus among 42 experts. Results: The panelists agreed on the need for educational and organizational changes in the current medical practices for diagnosing and treating B12 deficiency. Recognition of clinical symptoms should receive the highest priority in establishing the diagnosis. There is agreement that the serum B12 concentration is useful as a screening marker and methylmalonic acid or homocysteine can support the diagnosis. Patient lifestyle, disease history, and medications can provide clues to the cause of B12 deficiency. Regardless of the cause of the deficiency, initial treatment with parenteral B12 was regarded as the first choice for patients with acute and severe manifestations of B12 deficiency. The use of high-dose oral B12 at different frequencies may be considered for long-term treatment. Prophylactic B12 supplementation should be considered for specific high-risk groups. Conclusions: There is a consensus that clinical symptoms need to receive more attention in establishing the diagnosis of B12 deficiency. B12 laboratory markers can support the diagnosis. The severity of clinical symptoms, the causes of B12 deficiency, and the treatment goals govern decisions regarding the route and dose of B12 therapy.
RESUMEN
Increases in the prevalence of type 2 diabetes of 30-60% will occur in many Asian-Pacific countries by 2025, driven by urbanisation, sedentary habits and energy-rich diets. Obesity, insulin resistance, metabolic syndrome and diabetes are closely interrelated. Optimal control of diabetes and associated risk factors has reduced the risk of diabetes-related complications. In the UK Prospective Diabetes Study (UKPDS), metformin reduced the risk of macrovascular complications and retrospective analyses have confirmed the efficacy of metformin in improving clinical outcomes in type 2 diabetic patients with a history of cardiovascular disease. This growing body of evidence has led to the recommendation of metformin as optimum initial pharmacotherapy in overweight type 2 diabetic patients. Obesity is less prevalent in the Asian-Pacific population than in Caucasian populations. Nevertheless, metformin has multiple beneficial metabolic effects, which provide sufficient rationale for it to be recommended as the initial oral anti-diabetic pharmacotherapy, alone or in combination, irrespective of body mass index. This recommendation is consistent with global guidelines and regional recommendations for the Asian-Pacific region from the International Diabetes Federation. These recommendations can serve as templates for development of local guidelines for Asian people with diabetes, given the ethnic and cultural diversity within the region.