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Metformin, the first-line treatment for T2D, induces vitamin B12 deficiency through calcium-dependent antagonism of the intrinsic factor-B12 complex absorption in the terminal ileum, with studies showing a 13% increased risk of deficiency per year of use and higher prevalence in patients using metformin for more than 4 years at doses exceeding 1000 mg daily [158]

Treatment Once diagnosis is established no treatment is needed

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This routine is simple, repeatable, and keeps your internal defenses primed