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Contrarily, a study with 8 GH-deficient subjects found that IGF-1 administration increased lipid oxidation (being this effect more potent when co-administered with GH), energy expenditure, and insulin resistance [108, 183]

UK guidance (MHRA and NICE) advises checking B12 levels in patients on metformin who develop symptoms of deficiency (anaemia, neuropathy) and considering periodic monitoring in those on long-term therapy