Vitamin B12 deficiency in patients with type 2 diabetes mellitus using metformin and the associated factors in Saudi Arabia.

OBJECTIVES: To assess the presence of vitamin B12 deficiency among metformin users and associated factors in patients with type 2 diabetes mellitus. METHODS: An observational cross-sectional study was conducted with 307 diabetic patients in the primary health care centers at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia between October 2017 and January 2018. Face-to-face interviews were conducted with the participants, using a designed checklist. RESULTS: The prevalence of vitamin B12 deficiency was (3.6%) and the majority of the sample had borderline B12 levels (66.1%). The vitamin B12 deficiency and borderline levels were strongly associated with the dose of metformin. Patients taking doses of metformin more than 1000 mg had lower levels of vitamin B12. The use of multivitamin and vitamin B complex was assessed, and it was found that there was a marked decrease in the prevalence of vitamin B12 deficiency in patients using vitamin B complex containing more than 200 mcg vitamin B12. CONCLUSION: Our findings show a low prevalence of vitamin B12 deficiency in type 2 diabetic patients taking metformin. The majority of the sample had borderline deficiency; therefore, additional investigation and management are required.

Does physician distraction lead to diagnostic and management errors? An exploratory study in the primary care setting.

OBJECTIVES: There is an increasing concern about diagnostic errors and their impact on patient safety. Physicians' diagnostic ability is significantly undermined by certain distractions that can carry potential negative consequences such as diagnostic and management errors. This study aimed to examine the effects of distracting factors for physicians during consultation and their consequent effects on diagnostic accuracy and disease or condition management. METHODS: Family medicine residents at a major training hospital in KSA were randomly assigned to two groups of simulated patients: one group with patients with distracting features and another group with patients without distracting features (the control group). Both groups encountered six simulated patients with different clinical conditions or diseases. The consultation time, accuracy of diagnosis, appropriateness of management, number of outlines of treatment, and simulated patient satisfaction were measured for both groups. RESULTS: A total of 70 simulated physician-patient encounters were conducted with 35 residents. Consultation time was significantly longer for encounters with patients with distracting features, which had a mean time of 7.43 min, compared with encounters with non-distracting patients, which had a mean time of 4.4 min (p value < 0.0001). There were no significant statistical differences in accuracy of diagnosis, appropriateness of management, or patient satisfaction between the two groups. However, residents recommended a higher number of outlines of treatment for patients with distracting features (2.96 for distracting patients versus 2.46 for non-distracting patients; p < 0.011). CONCLUSION: Distracting factors are associated with prolonged consultation time among physicians. Although this study did not demonstrate any effects of distracting factors on accuracy of diagnosis or disease management, these factors are still concerning, especially in complex clinical situations and situations where there is lack of reflective practice. The effects of distracting factors should be minimized to ensure patient safety.