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It is important to note that the glucose-raising effect of glucagon receptor activation is largely counterbalanced by the GLP-1 and GIP components

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This complex is then degraded in lysosomes and the released vitamin B12 is bound to a nonglycosylated carrier proteintranscobalamin (TC)

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Since then, many small, short-term studies have reported an increased risk for biochemical vitamin B12 deficiency in patients taking metformin, with an incidence ranging from 5.6% to 36%.2-4 A large long-term study published in 2016 reaffirmed that B12 deficiency affects a small but significant proportion of patients taking metformin.5 This study analyzed data on 1,800 participants from the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study who were at high risk for T2DM