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There is around a 2.5-fold increase in B12 deficiency incidence in those treated with metformin, and this may occur as early as 3 months, although hepatic stores of vitamin B12 may take 5 years or more to deplete (Bell, 2022)

3.2 Quality assessment and risk of bias According to the Jadad scale for RCTs (n = 13) (Table 3 to provide a comprehensive appraisal

68 Detailed analysis suggests a multipronged effect of the changes in intestinal claudin-1 expression, including mucosal barrier properties (mucin-2 expression) and epithelial homeostasis

Reconstituted peptides require refrigeration at 2 to 8 degrees Celsius and should be used within their stability window