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Stage 2: Decreased levels of B12 and metabolic abnormalities such as high homocysteine or methylmalonic acid (MMA) levels

Anyone on long-term metformin, PPIs, or a GLP-1 protocol with significantly reduced intake for months should have B12 checked as part of routine monitoring

quiz 106 Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J: Effective treatment of cobalamin deficiency with oral cobalamin