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5.2 Limitations of One-Two Punch therapy One-Two Punch therapy, like any other form of treatment, faces certain limitations and challenges

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The prevalence of B12 deficiency in those older than 60 years is between 10% and nearly 20%.7,8 Because multiple causes can coexist in elderly patients, including poor absorption, protracted metformin use, and reduced dietary intake, these patients have the greatest risk for B12 deficiency and should be carefully monitored for signs of deficiency