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It can take up to 5 years before a deficiency manifests itself clinically, and NPs should be aware and alert to the possibility of B12 deficiency in their patients on prolonged metformin

doi: 10.5664/jcsm.7936

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If DNA synthesis and/or methylation (epigenetic events) are altered in utero, this could affect gene expression thus impacting fetal development and that could modulate the fetal susceptibility to various diseases