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Diabetes-induced endothelial dysfunction impairs blood, causing vasoconstriction

We list it as our high-potency pick for two specific scenarios: anyone with documented deficiency working to replete liver stores, and anyone whose absorption is significantly compromised (long-term metformin + PPI combination, post-bariatric surgery, atrophic gastritis on biopsy)

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In response to commenters' requests for clarification on whether the measure includes transfer patients, we clarify that transfer patients are included and assessed against all numerator criteria

Long-term systemic effects and interspecies variability are ongoing areas of investigation