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observed that the association of vitamin B 12 deficiency along with the concomitant use of metformin and proton pump inhibitors was significantly greater than those on monotherapy
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Recent studies have shown that insulin-mediated suppression of hepatic gluconeogenesis occurs indirectly through the ability of insulin to suppress adipocyte lipolysis and the flux into liver pyruvate carboxylase, the rate-limiting enzyme in gluconeogenesis (183, 200)
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