4 For example, the American Diabetes Association and American Association of Clinical Endocrinologists recommend the use of metformin as first-line treatment for type 2 diabetes mellitus and prediabetes to prevent progression of the disease. It has been reported that metformin is a pharmacological cause of vitamin B deficiencies in patients with type 2 diabetes mellitus which leads to long-term deleterious neurological and hematological effects.
Vitamin B
12 is a water-soluble vitamin that plays a fundamental role in DNA synthesis, optimal hemopoiesis, and neurological function. In the human body, vitamin B
12 is converted enzymatically into its two coenzyme forms, methylcobalamin and adenosylcobalamin.
8–10 Through its active forms, vitamin B
55 which revealed that males have a higher risk of hyperuricemia. The higher likelihood of hyperuricemia in males than females may be due to the action of sex hormones, in that the female sex hormone estrogen helps in the excretion of uric acid and could have the ability to maintain blood uric acid levels.
56,57 Besides, the risk of exposure to environmental and dietary factors that aid the synthesis of purine is higher in males than females, which may also contribute to the production of more uric acid owing to regulatory activity of purine metabolism, which further results in the release of high levels of uric acid into the circulation.