Scoping review protocol- Scoping review Vitamin B12 deficiency in long term metformin use and clinician awareness

IntroductionA relationship between long-term metformin use and vitamin B12 deficiency has been long discussed in literature. Nonetheless, prior to 2022, there was no official guidance. In June 2022, the MHRA published advice, stating that low vitamin B12 is now considered to be a common side effect. It advises checking levels in patients with symptoms of B12 deficiency, as well as monitoring those at risk of B12 deficiency. Despite efforts to promote evidence-based practice, there is still a gap in the translation of research findings into policies and clinical practice. The above research has been shared widely in the academic and specialist Diabetes literature over a prolonged period. The purpose of the scoping review is to explore what evidence is available regarding clinicians awareness of the association between metformin use and vitamin B12 deficiency in patients with T2DM and how this evidence is implemented into frontline clinical practice and what screening processes are recommended or exist? Methods and analysisThis is a protocol for a scoping review to be guided by the Joanna Briggs Institute (JBI) methodology for scoping reviews 20. The databases to be searched will include CINAHL, MEDLINE, EMBASE, British Nursing Index, via EBSCOhost. Sources of unpublished studies, policies and grey literature will include Google Scholar, the Cochrane Library, ProQuest Dissertations and Theses Open. Titles and abstracts of articles were reviewed by the authors. If articles were representative of the inclusion criteria, the articles went through a full-text review by the authors The results of the search and study inclusion/exclusion process will be reported and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram. Data will be extracted from papers, using the recommended JBI data extraction tool. Strengths and limitations of this studyO_LITo the authors knowledge, this is the first scoping review to look at clinician awareness of Vitamin B12 deficiency in long term metformin use. C_LIO_LIStrengths include an extensive search of multiple databases, including grey literature. C_LIO_LIAs this is a scoping review, the quality of the evidence and risk of bias will not be evaluated. C_LIO_LIThe review is also limited to selected languages which may bias the evidence. C_LI