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Accordingly, it has issued new advice to check vitamin B12 serum levels in patients being treated with metformin who have symptoms suggestive of vitamin B12 deficiency.[] The proposed mechanisms to explain metformin-induced vitamin B12 deficiency among patients with T2DM include alterations in small bowel motility, which stimulates bacterial overgrowth and consequential vitamin B12 deficiency, competitive inhibition or inactivation of vitamin B12 absorption, alterations in IF levels, and interaction with the cubulin endocytic receptor
NICE guidelines are intended to help ensure that people have equal access to treatment, regardless of where they live
Interestingly, most people are deficient in vitamin B12, especially vegetarians or vegans, and persons with specific diseases
A 2025 meta-analysis of 16 studies involving 6,098 participants found no statistically significant difference between intramuscular, oral, and sublingual B12 supplementation routes
It should be injected subcutaneously into the upper arms, abdomen, or thighs as directed by a medical provider
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