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It's important to note that long-term use of certain diabetes medications, including GLP-1 receptor agonists like semaglutide, may be associated with an increased risk of vitamin B12 deficiency [1]

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Pernicious anemia (D51.0): The most common primary indication

Despite this, cyanocobalamin has been increasingly criticised in recent years, due to the following reasons: Toxicity: cyanocobalamin is often claimed to be toxic, as the cyano group form the poison cyanide