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The definition of vitamin B12 deficiency varies with the assay used but generally includes serum cobalamin levels below 148 pmol/L plus symptoms, or elevated serum homocysteine, or increased methylmalonic acid (MMA) (74)
It is not necessary to withhold vitamin B12 therapy until the precise cause of B12 deficiency is established since absorption studies can be performed at any time
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Third, it stimulates glucose-dependent insulin secretion from pancreatic beta cells while suppressing inappropriate glucagon release improving glycemic control without significant hypoglycemia risk
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