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Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Vitamin B\n                      <jats:sub>12<\/jats:sub>\n                      deficiency is a recognised adverse effect of long-term metformin use. In 2022, the United Kingdom (UK) Medicines and Healthcare products Regulatory Agency (MHRA) issued a Drug Safety Update advising clinicians to consider periodic vitamin B\n                      <jats:sub>12<\/jats:sub>\n                      monitoring in at-risk patients. However, no specific testing interval or operational guidance has been published, and uptake within primary care remains uncertain. This study aimed to assess clinician awareness of metformin-associated vitamin B\n                      <jats:sub>12<\/jats:sub>\n                      deficiency, evaluate the impact of the MHRA alert, and identify perceived barriers and facilitators to implementing evidence-based monitoring practices.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional online survey was distributed to primary care clinicians across the Southwest of England. Eligible participants included registered healthcare professionals involved in Type 2 Diabetes (T2DM) care. The validated BARRIERS scale was used to measure factors influencing evidence use, with internal consistency assessed using Cronbach\u2019s \u03b1. Descriptive and inferential statistics, including Chi-squared and Kruskal\u2013Wallis tests, were applied to explore associations between professional role, awareness, and testing behaviour.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 124 clinicians completed the survey (approximate response rate 48%), representing a multidisciplinary primary-care workforce. Reported awareness of the association between metformin and vitamin B\n                      <jats:sub>12<\/jats:sub>\n                      deficiency was high (87%), yet only 35% had read the MHRA alert directly, and 39% reported annual vitamin B\n                      <jats:sub>12<\/jats:sub>\n                      testing. No significant associations were found between awareness, professional role, or testing frequency (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). The highest mean barrier scores were within the innovation domain, reflecting ambiguity around the clarity and applicability of guidance, while the adopter domain recorded the highest facilitator scores, indicating strong individual motivation when supported by accessible resources.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Clinician knowledge of metformin-related vitamin B\n                      <jats:sub>12<\/jats:sub>\n                      deficiency is high, but behavioural change remains limited by unclear guidance and organisational constraints. Barriers relate predominantly to the characteristics of the innovation and its implementation context rather than individual motivation. Integrating vitamin B\n                      <jats:sub>12<\/jats:sub>\n                      monitoring into existing T2DM review templates and strengthening national guidance could enhance uptake.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12875-026-03185-w","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T10:04:15Z","timestamp":1769508255000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinician awareness and implementation of vitamin B12 monitoring guidance in metformin users: a primary care survey"],"prefix":"10.1186","volume":"27","author":[{"given":"Ian","family":"Parsonage","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Wainwright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Barratt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"3185_CR1","unstructured":"Diabetes UK. 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