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The authors express concern that there is not yet clear guidance on supplementation route and methods, and they discuss studies exploring this

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Otherwise, intestinal ischemia[59] appears as the final consequence of blood pooling in the splanchnic bed, inducing portal hypertension, and multivisceral edema, and mesenterial venous occlusion, could also induce intestinal injury as early as within 5 min

[DOI] [PMC free article] [PubMed] [Google Scholar] 26.Sohn KC, Shi G, Jang S, et al

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The biggest change to current clinical practice is likely to be the advice to consider periodic monitoring of B12 levels in patients taking metformin who are at risk of deficiency, which includes a wide range of our patients living with type 2 diabetes