Knowledge, Attitudes, and Practices of Pharmacists toward Vitamin B12 Deficiency Associated with Metformin Use: A Cross-Sectional Survey Study

Abstract

Metformin, a first-line therapy for type 2 diabetes mellitus (T2DM), is linked to vitamin B12 deficiency with long-term use
(≥1,500 mg/day), increasing risks of neuropathy and megaloblastic anaemia. Community pharmacists, as accessible healthcare
providers, are well-positioned to promote screening and education to mitigate these risks.
This cross-sectional survey was conducted among 100 pharmacists in Tripoli, Libya, using a structured self-administered
questionnaire to assess their knowledge, attitudes, and practices, (KAP) regarding metformin-associated vitamin B12 deficiency.
Descriptive statistics summarized responses, with chi-square tests and Pearson’s correlation used to examine associations (P <
0.05 was considered significant). Participants were predominantly young (mean age 28 ± 6.05 years) with a mean experience of
4.5 ± 5.2 years. Most (87%) recognized metformin’s link to B12 deficiency, and 77% identified reduced intestinal absorption.
Monitoring was frequent (57% always, 34% sometimes recommended screening; 65% observed deficiency cases). Awareness
was significantly associated with counselling frequency (χ² = 7.76, P = 0.041) and case observation (χ² = 8.27, P = 0.004),
while Practices were correlated with accurate symptom identification (χ² = 16.43, P < 0.001) and improved patient adherence to
monitoring (χ² = 8.22, P = 0.037). Positive attitudes (86% felt responsible for education) linked to better adherence outcomes (χ²
= 12.70, P < 0.001). Experience positively correlated with KAP (r > 0.22, P < 0.05). Barriers included patient disinterest (29%)
and time constraints (19%). While pharmacists demonstrated strong awareness and engagement, structured training programs
and national guidelines are needed to optimize counselling and improve patient outcomes