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While this effect appears to be related to the magnitude and rapidity of glucose lowering rather than a direct effect of the medication itself, patients with a history of diabetic retinopathy should undergo careful ophthalmologic evaluation before and during treatment, and the potential risks should be weighed against the expected benefits of improved glycemic control

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B12 is generally safe, but certain medicationssuch as metformin, proton pump inhibitors, or some antibioticscan impact B12 absorption or effectiveness

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