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Because metformin works through insulin pathway optimization, reducing fasting glucose and lowering insulin resistance, which the article says aligns with a high insulin resistance phenotype

Coverage is more likely if you have an underlying health condition that prevents your body from properly absorbing Vitamin B12 from food or supplements, such as pernicious anemia or certain gastrointestinal disorders, or if you have had specific surgeries like gastric bypass

The earlier Phase 1 trial of AZD5004/ECC5004 was conducted in the U.S

However: No large, peer-reviewed human trials exist demonstrating proven benefit