A 62-year-old woman with a 10-year history of type 2 diabetes mellitus comes to the clinic because of progressive fatigue, generalized weakness, and numbness of her feet over the past 6 months. She has been taking the same oral antidiabetic medication for several years and reports good medication adherence. She denies alcohol use and follows a balanced diet. Her BMI is 31 kg/m². Vital signs are within normal limits. Physical examination reveals decreased vibratory sensation in the bilateral lower extremities. Laboratory studies show a hemoglobin of 10.2 g/dL, MCV of 104 fL, macrocytosis on peripheral blood smear, and a low serum vitamin B12 level. Which of the following drugs is most likely responsible?
- A)Acarbose
- B)Glyburide
- C)Empagliflozin
- D)Pioglitazone
- E)MetforminGABARITO
Explicação
Long term metformin use can reduce vitamin B12 levels and lead to macrocytic anemia with neuropathic symptoms. This adverse effect is classically tested alongside its more familiar gastrointestinal toxicity and lactic acidosis risk in severe renal dysfunction. Ver explicação completa e trilha adaptativa →