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Indeed, clinical manifestations of vitamin B12 deficiency can become evident upon depletion of the body stores to as little as 5%-10%, which may occur several years (up to 10 years) after the initial exposure to metformin or to other risk factors or conditions predisposing to vitamin B12 deficiency[50]

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Elderly people may also be deficient, as the ability to absorb vitamin B12 decreases with age