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[DOI] [PMC free article] [PubMed] [Google Scholar] 93.Wiersinga W.J., Virk H.S., Torres A.G., Currie B.J., Peacock S.J., Dance D.A.B., Limmathurotsakul D

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For patients with clinical deficiency, effective replacement therapy should lead to a normal blood count after two months of treatment, while improvement in neurologic symptoms begins within one week after initiation of therapy and is usually complete within 6 weeks to 3 months.13 For patients with an asymptomatic biochemical deficiency (ie, subclinical disease), measurement of serum B12 or MMA levels should be done 2 to 3 months after initiation of replacement therapy.12 Once metformin is started, this medication is seldom discontinued unless advanced renal impairment develops

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