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In the randomized placebo-controlled HOME trial of 390 adults with type 2 diabetes (de Jager and colleagues, Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency, BMJ, 2010), metformin lowered serum B12 by a mean of 19 percent over 4.3 years

This is not a gap in medical knowledge so much as a reflection of how rapidly GLP-1 adoption has outpaced formal guideline development

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Jia et al., 2024

[4] Cardiovascular and renal outcomes: Clinical trials revealed that Ozempic significantly reduced the chance of cardiovascular events and slowed progression of chronic kidney disease