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Those on long-term metformin or PPIs should discuss monitoring requirements with their healthcare provider

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First, only two out of the four studies considered vitamin B 12 , methylmalonic acid and homocysteine levels as possible confounders for the response to vitamin B 12 therapy.(10,11) Vitamin B 12 deficiency is known to cause peripheral neuropathy and is a risk factor for development of DPN in diabetics who are on metformin