<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2182-5173</journal-id>
<journal-title><![CDATA[Revista Portuguesa de Medicina Geral e Familiar]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Port Med Geral Fam]]></abbrev-journal-title>
<issn>2182-5173</issn>
<publisher>
<publisher-name><![CDATA[Associação Portuguesa de Medicina Geral e Familiar]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2182-51732024000600581</article-id>
<article-id pub-id-type="doi">10.32385/rpmgf.v40i6.13675</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Défice de vitamina B12 em diabéticos sob metformina: um estudo transversal]]></article-title>
<article-title xml:lang="en"><![CDATA[Deficit of vitamin B12 in diabetics on metformin: a cross-sectional study]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Amaral]]></surname>
<given-names><![CDATA[Joana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pacheco]]></surname>
<given-names><![CDATA[Ana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sousa]]></surname>
<given-names><![CDATA[Eduardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Figueiredo]]></surname>
<given-names><![CDATA[Mariana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ornelas]]></surname>
<given-names><![CDATA[Mónica]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,ULS Almada/Seixal USF Amora Saudável ]]></institution>
<addr-line><![CDATA[Amora ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,ULS Almada/Seixal ECSCP Almada-Seixal ]]></institution>
<addr-line><![CDATA[Amora ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,ULS Almada/Seixal USF Rosinha ]]></institution>
<addr-line><![CDATA[Amora ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,ULS Almada/Seixal USF Amora Saudável ]]></institution>
<addr-line><![CDATA[Amora ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2024</year>
</pub-date>
<volume>40</volume>
<numero>6</numero>
<fpage>581</fpage>
<lpage>587</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2182-51732024000600581&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2182-51732024000600581&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2182-51732024000600581&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  A diabetes mellitus tipo 2 afeta cerca de 13,3% dos portugueses. A metformina foi durante muitos anos considerada a primeira linha farmacológica na diabetes, continuando atualmente recomendada em diabéticos sem comorbidades cardiorrenais. Até 30% dos diabéticos sob metformina apresentam défice de vitamina B12, que pode manifestar-se como neuropatia potencialmente irreversível, mimetizando a neuropatia diabética. O doseamento periódico de vitamina B12 encontra-se recomendado em várias fontes bibliográficas, não sendo, porém, consensual a sua metodologia.  Objetivos:  Identificar a prevalência de deficiência de vitamina B12 em diabéticos sob metformina e a sua relação com outras variáveis, visando reduzir comorbidades evitáveis e contribuir para o desenvolvimento de diretrizes médicas e terapêuticas mais precisas.  Métodos:  Este trabalho consiste num estudo transversal. Em sessão clínica sensibilizou-se a equipa médica de uma unidade de saúde familiar para o doseamento da vitamina B12 nos utentes diabéticos sob metformina. Critérios de inclusão: adultos com diagnóstico de diabetes mellitus tipo 2 sob tratamento com metformina. Critérios de exclusão: história de cirurgia bariátrica, diagnóstico de anemia perniciosa e diagnóstico de síndroma malabsortivo. Variáveis analisadas: doseamento de vitamina B12, proporção de défice, sintomatologia, duração do tratamento com metformina, dose de metformina utilizada, terapia simultânea com inibidores da bomba de protões e diagnóstico concomitante de hipotiroidismo.  Resultados:  Ao longo de 20 meses foram solicitados doseamentos de vitamina B12 a 362 diabéticos sob metformina. Destes, 58 diabéticos (18,02%) apresentaram défice e apenas seis utentes com défice de B12 apresentaram sintomas. Todos os indivíduos com défice encontravam-se sob metformina há seis ou mais anos e a dose de metformina mais utilizada na população com défice foi de 2000 mg/dia.  Conclusões:  Este doseamento periódico permite a correção precoce de possíveis défices e evita as suas consequências, como o desenvolvimento de uma neuropatia potencialmente irreversível em utentes diabéticos, população já dotada de grande fragilidade.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  Type 2 diabetes affects about 13.3% of the Portuguese population. Metformin was for many years considered first-line pharmacology in diabetes and is currently still recommended as such in diabetics without cardiorenal comorbidities. Up to 30% of diabetics on metformin have vitamin B12 deficiency, which can manifest as potentially irreversible neuropathy, mimicking diabetic neuropathy. Periodic dosing of vitamin B12 is recommended in several bibliographic sources, however there is no consensus on its methodology.  Objectives:  We aim to identify the prevalence of vitamin B12 deficiency in patients undergoing metformin therapy and its relationship with other variables, reducing avoidable comorbidities and contributing to developing more precise therapeutic and medical guidelines.  Methods:  This work consists of a cross-sectional study. The medical team of a primary healthcare unit attended a clinical session about the importance of measuring the blood levels of vitamin B12 in patients with type 2 diabetes under metformin. Inclusion criteria: adults diagnosed with type 2 diabetes treated with metformin. Exclusion criteria: history of bariatric surgery, diagnosis of pernicious anemia, and diagnosis of malabsorptive syndrome. Variables analyzed: vitamin B12 serum levels, proportion of deficit, symptomatology, duration of treatment with metformin, dose of metformin used, simultaneous therapy with proton pump inhibitors, and concurrent diagnosis of hypothyroidism.  Results:  Over 20 months, vitamin B12 measurements of 362 diabetic patients on metformin were requested. Of these, 58 patients (18.02%) showed a deficit and only six patients with B12 deficit presented symptoms. All individuals with a deficit had been using metformin for 6 years or more and the more commonly used dose of metformin in the population with deficit was 2000 mg/day.  Conclusions:  This periodic measurement allows early correction of possible deficits and avoids their consequences, such as the development of a potentially irreversible neuropathy in diabetic patients, a population already holding great frailty.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Défice de vitamina B12]]></kwd>
<kwd lng="pt"><![CDATA[Metformina]]></kwd>
<kwd lng="pt"><![CDATA[Neuropatia periférica]]></kwd>
<kwd lng="en"><![CDATA[Vitamin B12 deficiency]]></kwd>
<kwd lng="en"><![CDATA[Metformin]]></kwd>
<kwd lng="en"><![CDATA[Peripheral neuropathy]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="book">
<collab>International Diabetes Federation</collab>
<source><![CDATA[IDF diabetes atlas]]></source>
<year>2017</year>
<edition>8</edition>
<publisher-loc><![CDATA[Brussels ]]></publisher-loc>
<publisher-name><![CDATA[IDF]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="book">
<collab>Observatório Nacional da Diabetes</collab>
<source><![CDATA[Diabetes: factos e números (o ano de 2015)]]></source>
<year>2016</year>
<publisher-loc><![CDATA[Lisboa ]]></publisher-loc>
<publisher-name><![CDATA[ONC]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<collab>American Diabetes Association</collab>
<article-title xml:lang=""><![CDATA[Standards of medical care in diabetes - 2017]]></article-title>
<source><![CDATA[Diabetes Care]]></source>
<year>2017</year>
<volume>40</volume>
<numero>Suppl 1</numero>
<issue>Suppl 1</issue>
<page-range>1-142</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<collab>American Diabetes Association</collab>
<article-title xml:lang=""><![CDATA[Standards of care in diabetes - 2023 abridged for primary care providers]]></article-title>
<source><![CDATA[Clin Diabetes]]></source>
<year>2022</year>
<volume>41</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>4-31</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zalaket]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Wehbe]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Jaoude]]></surname>
<given-names><![CDATA[EA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Vitamin B12 deficiency in diabetic subjects taking metformin a cross-sectional study in a Lebanese cohort]]></article-title>
<source><![CDATA[J Nutr Intermed Metab]]></source>
<year>2018</year>
<volume>11</volume>
<page-range>9-13</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Qureshi]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
<name>
<surname><![CDATA[Ainsworth]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Winocour]]></surname>
<given-names><![CDATA[PH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Metformin therapy and assessment for vitamin B12 deficiency is it necessary?]]></article-title>
<source><![CDATA[Pract Diabetes]]></source>
<year>2011</year>
<volume>28</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>302-4</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Aroda]]></surname>
<given-names><![CDATA[VR]]></given-names>
</name>
<name>
<surname><![CDATA[Edelstein]]></surname>
<given-names><![CDATA[SL]]></given-names>
</name>
<name>
<surname><![CDATA[Goldberg]]></surname>
<given-names><![CDATA[RB]]></given-names>
</name>
<name>
<surname><![CDATA[Knowler]]></surname>
<given-names><![CDATA[WC]]></given-names>
</name>
<name>
<surname><![CDATA[Marcovina]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
<name>
<surname><![CDATA[Orchard]]></surname>
<given-names><![CDATA[TJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Long-term metformin use and vitamin B12 deficiency in the Diabetes Prevention Program Outcomes Study]]></article-title>
<source><![CDATA[J Clin Endocrinol Metab]]></source>
<year>2016</year>
<volume>101</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>1754-61</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bauman]]></surname>
<given-names><![CDATA[WA]]></given-names>
</name>
<name>
<surname><![CDATA[Shaw]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Jayatilleke]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Spungen]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Herbert]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin]]></article-title>
<source><![CDATA[Diabetes Care]]></source>
<year>2000</year>
<volume>23</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>1227-31</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tomkin]]></surname>
<given-names><![CDATA[GH]]></given-names>
</name>
<name>
<surname><![CDATA[Hadden]]></surname>
<given-names><![CDATA[DR]]></given-names>
</name>
<name>
<surname><![CDATA[Weaver]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Montgomery]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Vitamin-B12 status of patients on long-term metformin therapy]]></article-title>
<source><![CDATA[Br Med J]]></source>
<year>1971</year>
<volume>2</volume>
<numero>5763</numero>
<issue>5763</issue>
<page-range>685-7</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tomkin]]></surname>
<given-names><![CDATA[GH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Malabsorption of vitamin B12 in diabetic patients treated with phenformin a comparison with metformin]]></article-title>
<source><![CDATA[Br Med J]]></source>
<year>1973</year>
<volume>3</volume>
<numero>5882</numero>
<issue>5882</issue>
<page-range>673-5</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Caspary]]></surname>
<given-names><![CDATA[WF]]></given-names>
</name>
<name>
<surname><![CDATA[Creutzfeldt]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Analysis of the inhibitory effect of biguanides on glucose absorption inhibition of active sugar transport]]></article-title>
<source><![CDATA[Diabetologia]]></source>
<year>1971</year>
<volume>7</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>379-85</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bhise]]></surname>
<given-names><![CDATA[SB]]></given-names>
</name>
<name>
<surname><![CDATA[Kadam]]></surname>
<given-names><![CDATA[YD]]></given-names>
</name>
<name>
<surname><![CDATA[Ismaeel]]></surname>
<given-names><![CDATA[GL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Effect of vitamin B12 supplement in metformin treated diabetic patients and it's correlation to peripheral neuropathy]]></article-title>
<source><![CDATA[Int J Pharma Res Health Sci]]></source>
<year>2018</year>
<volume>6</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>2394-400</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Castellanos-Sinco]]></surname>
<given-names><![CDATA[HB]]></given-names>
</name>
<name>
<surname><![CDATA[Ramos-Peñafiel]]></surname>
<given-names><![CDATA[CO]]></given-names>
</name>
<name>
<surname><![CDATA[Santoyo-Sánchez]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Collazo-Jaloma]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez-Murillo]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Montaño-Figueroa]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Megaloblastic anaemia folic acid and vitamin B12 metabolism]]></article-title>
<source><![CDATA[Rev Med Hosp Gen Mexico]]></source>
<year>2015</year>
<volume>78</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>135-43</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Berard]]></surname>
<given-names><![CDATA[LD]]></given-names>
</name>
<name>
<surname><![CDATA[Siemens]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Woo]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Monitoring glycemic control]]></article-title>
<collab>Diabetes Canada Clinical Practice Guidelines Expert Committee</collab>
<source><![CDATA[Can J Diabetes]]></source>
<year>2018</year>
<volume>42</volume>
<numero>^s1</numero>
<issue>^s1</issue>
<supplement>1</supplement>
<page-range>S47-53</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Whitbourne]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<source><![CDATA[Vitamin B12: what to know]]></source>
<year>2017</year>
<publisher-name><![CDATA[WebMD]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bell]]></surname>
<given-names><![CDATA[DS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Nondiabetic neuropathy in a patient with diabetes]]></article-title>
<source><![CDATA[Endocr Pract]]></source>
<year>1995</year>
<volume>1</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>393-4</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bello]]></surname>
<given-names><![CDATA[CT]]></given-names>
</name>
<name>
<surname><![CDATA[Capitão]]></surname>
<given-names><![CDATA[RM]]></given-names>
</name>
<name>
<surname><![CDATA[Duarte]]></surname>
<given-names><![CDATA[JS]]></given-names>
</name>
<name>
<surname><![CDATA[Azinheira]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Vasconcelos]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Défice de vitamina B12 na diabetes mellitus tipo 2]]></article-title>
<source><![CDATA[Acta Med Port]]></source>
<year>2017</year>
<volume>30</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>719-26</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[De Jager]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Kooy]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Lehert]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Wulffelé]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Long term treatment with metformin in patients with type diabetes and risk of vitamin B deficiency randomised placebo controlled trial]]></article-title>
<collab>van der Kolk J.Bets D</collab>
<source><![CDATA[BMJ]]></source>
<year>2010</year>
<volume>340</volume>
<page-range>c2181</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kang]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Yun]]></surname>
<given-names><![CDATA[JS]]></given-names>
</name>
<name>
<surname><![CDATA[Ko]]></surname>
<given-names><![CDATA[SH]]></given-names>
</name>
<name>
<surname><![CDATA[Lim]]></surname>
<given-names><![CDATA[TS]]></given-names>
</name>
<name>
<surname><![CDATA[Ahn]]></surname>
<given-names><![CDATA[YB]]></given-names>
</name>
<name>
<surname><![CDATA[Park]]></surname>
<given-names><![CDATA[YM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Higher prevalence of metformin-induced vitamin B12 deficiency in sulfonylurea combination compared with insulin combination in patients with type2 diabetes a cross-sectional study]]></article-title>
<source><![CDATA[PLoS One]]></source>
<year>2014</year>
<volume>9</volume>
<numero>10</numero>
<issue>10</issue>
</nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fogelman]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Kitai]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Blumberg]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Golan-Cohen]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Rapoport]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Carmeli]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Vitamin B12 screening in metformin-treated diabetics in primary care were elderly patients less likely to be tested?]]></article-title>
<source><![CDATA[Aging Clin Exp Res]]></source>
<year>2017</year>
<volume>29</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>135-9</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<collab>Kidney Disease - Improving Global Outcomes Diabetes Work Group</collab>
<article-title xml:lang=""><![CDATA[KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease]]></article-title>
<source><![CDATA[Kidney Int]]></source>
<year>2022</year>
<volume>102</volume>
<numero>5 Suppl</numero>
<issue>5 Suppl</issue>
<page-range>S1-127</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nagao]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Hirakawa]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnosis and treatment of macrocytic anemias in adults]]></article-title>
<source><![CDATA[J Gen Fam Med]]></source>
<year>2016</year>
<volume>18</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>200-4</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Inácio]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Azevedo]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Balsa]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Alves]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Dantas]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Ferreira]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Relationship between metformin use and vitamin B12, homocysteine and methylmalonic acid levels in patients with type 2 diabetes]]></article-title>
<source><![CDATA[Rev Port Diabetes]]></source>
<year>2022</year>
<volume>17</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>15-22</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
