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In June 2022 the UK medicines regulator updated its advice: the MHRA now lists low vitamin B12 as a common side effect of metformin, meaning it can affect up to one in ten people taking it
In-vitro assays show the molecule is membrane-permeable, which supports the possibility of oral absorption, but the animal efficacy studies used injection, and no study has directly compared oral versus subcutaneous bioavailability
The existing evidence supporting its use is weak and often compromised by conflicts of interest
Thompson, K.L., et al
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