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Consider periodic monitoring of B12 in patients on metformin with risk factors for B12 deficiency Risk factors are quite wide-ranging and include the following (MHRA, 2022): Baseline vitamin B12 levels at the lower end of the normal range

The limitations of this work are that we included RCTs, non-RCTs, and observational studies, which may lower the overall quality of evidence of the included studies

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As many are deficient the maximum recommended dose allowed is 300,000 IU

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We monitor patients and adjust protocols based on response