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Guidelines suggest the additional use of DPP-4 inhibitors after metformin failure in patients that do not require antidiabetic therapy with proven cardiovascular benefit

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In addition, a deficiency of vitamin B12 can cause facial signs such as hyperpigmentation (dark spots), vitiligo (white patches where skin loses color), or angular stomatitis (inflammation at the corners of the mouth)

Some patients receive B12 shots as part of a regular wellness routine, while others book them as needed