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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

We read with great interest the case report by Gilligan¹ about metformin-associated vitamin B₁₂ deficiency. To date, only case reports or small studies have described patients with biguanide-associated decreased vitamin B₁₂ levels or true vitamin B₁₂ deficiency. Thus, we would like to offer some elements about our own experience with this unfamiliar cause of cobalamin deficiency in adults.

Since 1995, 162 patients with established cobalamin deficiency (serum vitamin B₁₂ level <200 pg/mL [147.6 pmol/L] confirmed in 2 samples [RIA; Bayer Corp, New York, NY]) have been registered in a prospective cohort study at the University Hospital of Strasbourg, France (partial data previously published²). Ten patients with metformin-associated cobalamin deficiency have been registered. Clinical characteristics of these 10 patients are described herein. Values are given as mean ± SD.

Metformin (Glucophage or Stagid; Lipha Santé, Lyon, France) was used at a daily dose of 2015 ± 450 mg (range, 1400-2550 . . . [Full Text of this Article]

Corresponding author: Emmanuel Andrès, MD, Service de Médecine Interne, Diabete et Maladies Métaboliques, Clinique Médicale B, 1 place de l'Hôpital, 67 091 Strasbourg CEDEX, France (e-mail: emmanuel.andres@chru-strasbourg.fr).

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