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A multicenter trial of 390 patients with diabetes mellitus receiving insulin therapy who were randomized to receive metformin, 850 mg three times daily, or placebo assessed the risk of vitamin B 12 deficiency and low vitamin B 12 levels over four years

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[39] The elderly are at increased risk because they tend to produce less stomach acid as they age, a condition known as achlorhydria, thereby increasing their probability of B 12 deficiency due to reduced absorption