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These include situations where metformin is ineffective, contraindicated, or when patients fail to reach their target glycemic control despite treatment with metformin and other medications

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Sublingual B12, which bypasses the gastrointestinal tract, is the least invasive and potentially most cost-effective option, especially for individuals with impaired absorption, making it an attractive alternative for long-term and patient-friendly management (Houle et al., 2014