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It is recommended that metformin treatment should continue while the B12 deficiency is corrected, in view of the drugs known benefits in type 2 diabetes and its central role in treatment guidelines.

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Inadequate secretion of intrinsic factor, resulting from lesions that destroy the gastric mucosa (ingestion of corrosives, extensive neoplasia), and a number of conditions associated with a variable degree of gastric atrophy (such as multiple sclerosis, certain endocrine disorders, iron deficiency, and subtotal gastrectomy)

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