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Notably, GLP-1RAs were consistently linked to increased GI adverse effects such as nausea, dyspepsia, and constipation, with high or moderate certainty

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However, as genotyping is not currently routinely available and serum vitamin B 12 measurement is cheap, our results reinforce the causal association of metformin treatment with vitamin B 12 deficiency and guideline recommendations for routine screening for vitamin B 12 deficiency in people treated with metformin