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The MHRA recommends monitoring B12 levels in patients on long-term metformin treatment

Conditions like pernicious anaemia (an autoimmune condition affecting a protein called intrinsic factor vital for B12 absorption), stomach issues (such as from reduced stomach acid or certain medications like proton pump inhibitors), intestinal disorders (like Crohns disease or coeliac disease), or even surgical removal of parts of the small intestine (e.g., gastric bypass surgery) can prevent proper absorption

Older individuals, especially women, are at risk of developing osteoporosis: a condition that causes weak and fragile bones

High Vitamin B12 Levels: Causes, Symptoms, and How to Manage Them Worried about high vitamin B12