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However, as genotyping is not currently routinely available and serum vitamin B 12 measurement is cheap, our results reinforce the causal association of metformin treatment with vitamin B 12 deficiency and guideline recommendations for routine screening for vitamin B 12 deficiency in people treated with metformin

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As it does not directly increase DA levels, ATX often produces less severe side effects while reducing abuse risk linked to DA modulation of reward pathways [219]

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The real risk is not just that peptide therapy may fail