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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)

Dual mechanism addresses both insulin and glucagon pathways

Also, those who have anemia or are vegetarian or vegan will want to consider a B12 regimen, as vegetable-based diets generally dont contain the amount of B12 that you need to thrive

Clin Cancer Res 23:23252334

This rigorous methodology minimizes bias and allows for accurate attribution of adverse effects to the intervention rather than background health conditions or placebo effects