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Hence, clinicians should correct vitamin B12 deficiency in patients treated with metformin following the British Society for Haematology guidelines for diagnosis and treatment of vitamin B12 deficiency[62]

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In these groups of patients with risk factors who are taking metformin, especially over the long term, the new MHRA guidance suggests we should consider checking vitamin B12 levels as part of annual review bloods this is a significant change to current typical practice

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Small number of research groups : A limited number of research groups have conducted most studies, which may affect the generalizability of the results