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It can take up to 5 years before a deficiency manifests itself clinically, and NPs should be aware and alert to the possibility of B12 deficiency in their patients on prolonged metformin

The commenter noted that the lack of investment in Tribal REHs would hinder their ability to modernize their EHR system and urged cross-agency collaboration across HHS to modernize EHR systems for REHs

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Vitamin B Deficiency: While only 1-1.5 percent of Americans have a true deficiency, as many as 40 percent fall within the low-normal range for Vitamin B levels

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