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Additional mechanisms include modulation of gut microbiota composition, inhibition of mitochondrial complex I, and effects on lipid metabolism

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Effect of pioglitazone versus insulin glargine on cardiac size, function, and measures of fluid retention in patients with type 2 diabetes

This includes individuals with medical conditions such as pernicious anemia, atrophic gastritis, celiac disease, or Crohns disease, all of which can interfere with B12 absorption