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bmjopen.bmj.comHH Phan, Nguyen ATT (2025) MD DoBMJ open, 2025bmjopen.bmj.com 15:100672 Sato Y, Ouchi K, Funase Y, Yamauchi K, Aizawa T Relationship between metformin use, vitamin B12 deficiency, hyperhomocysteinemia and vascular complications in patients with type 2 diabetes

Treatment often involves dietary changes or vitamin B12 supplements.

Altered B12 handling and reduced clearance in kidney disease, and both cellular release and reduced clearance in liver disease, can raise B12, so supportive renal or hepatic findings make those causes plausible

MICC includes B12 plus lipotropics (methionine, inositol, choline) for a broader fat-metabolism focus

The injury you have and the treatment plan youre following play a massive role in how long it takes to see meaningful progress

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