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Week 2 to 4: skin and recovery changes
Nevertheless, use of metformin may decrease vitamin B 12 status: a meta-analysis of four short-term intervention trials (up to 4 months duration) in patients with type 2 diabetes found that metformin use decreased serum cobalamin concentrations by 57 pmol/L, which could have clinical implications if such patients have suboptimal vitamin B 12 status (146)
Over time, this can lead to inflammation, high blood pressure, poor circulation, and diseases like atherosclerosis, autoimmune disorders, infections, and organ failure
doi: 10.1016/j.pain.2013.11.013
