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Metformin is a drug increasingly used as a first-line treatment for type 2 diabetes mellitus. In this country, there is less experience with the drug than in England and Europe, where it has been used for decades. The drug is well tolerated in most patients. The primary adverse effect discussed in the North American literature is lactic acidosis, which is seen in patients with renal insufficiency and those undergoing radiologic procedures using contrast dye. Another well-documented but little-discussed adverse effect, notably omitted from an article in the ARCHIVES on laboratory diagnosis of B₁₂ deficiency,¹ is biguanide-associated decreased levels of vitamin B₁₂. The following case highlights this problem.

Report of a Case

Our patient was a 63-year-old white man with a medical history of type 2 diabetes mellitus for 12 years. He was not a vegetarian and had no history of bowel surgery. He also had a 3-year history of chronic nausea and vomiting. . . . [Full Text of this Article]

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