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Oral supplements require intrinsic factor for absorption, and many people (especially those over 50) have reduced absorption capacity

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Baseline vitamin B12 levels before starting metformin Annual monitoring for patients on long-term metformin therapy Consideration of vitamin B12 supplementation if deficiency is detected Antibiotics and Chemotherapy Agents That Affect B12 Metabolism Certain antibiotics and chemotherapy agents can harm vitamin B12 metabolism

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10.1126/scitranslmed.aay8071 [DOI] [PMC free article] [PubMed] [Google Scholar] Ghosh P., Fontanella R

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