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Conclusion We found that the use of metformin at doses equal to or greater than 1500 mg/d is a major factor related to the development of vitamin B12 deciency, and that concurrent supplementation of multivitamins may potentially protect against this

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The absence of longitudinal clinical data in FAERS precludes adjustment for these factors

However, synthetic B12 in supplements is already in free form and does not require the same initial digestive processes