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Nevertheless, use of metformin may decrease vitamin B 12 status: a meta-analysis of four short-term intervention trials (up to 4 months duration) in patients with type 2 diabetes found that metformin use decreased serum cobalamin concentrations by 57 pmol/L, which could have clinical implications if such patients have suboptimal vitamin B 12 status (146)

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Some signs that you may have a B12 deficiency include symptoms like fatigue, cognitive issues like brain fog, low energy, feelings of weakness, and tingling or numbness in the limbs