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Acute pancreatitis, gallbladder events, thyroid C-cell concerns (a rat-derived signal that has never been confirmed in humans), and diabetic retinopathy progression in patients with existing retinopathy

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The evidence base is primarily observational and retrospective , with limited randomised controlled trial data specifically in post-bariatric populations

Avoid freezing If medication freezes, it becomes unusableeven if thawed later

Metformin is well-established as reducing B12 absorption , primarily through interference with calcium-dependent B12-intrinsic factor uptake in the terminal ileum

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