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Safety and efficacy of once-weekly dulaglutide versus sitagliptin after 2 years in metformin-treated patients with type 2 diabetes (AWARD-5): a randomized, phase III study
The concern is amplified in specific patient groups who are already at elevated risk of B12 deficiency, including: Older adults , in whom gastric acid secretion naturally declines with age Individuals following vegetarian or vegan diets , who may have limited dietary B12 intake Those taking metformin , a commonly co-prescribed medicine for type 2 diabetes that is independently associated with reduced B12 absorption the MHRA Drug Safety Update (2022) advises monitoring B12 in symptomatic or at-risk patients taking metformin [13] Patients taking long-term proton pump inhibitors (PPIs) or H2-receptor antagonists , which reduce gastric acid and may impair B12 release from food Patients with a history of gastrointestinal surgery , including bariatric procedures Those with pernicious anaemia or other autoimmune conditions affecting intrinsic factor production Patients with coeliac disease, inflammatory bowel disease, or significant alcohol use , which may impair absorption Vitamin B12 plays an essential role in red blood cell formation, neurological function, and DNA synthesis
Past and current GLP-1 users (46% and 43%, respectively) were more likely to do so than non-users (25%)
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