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NPs who prescribe metformin for an extended period, no matter the indication (eg, T2DM prevention and treatment, polycystic ovary syndrome), should consider B12 supplementation as well as perform routine measurement of vitamin B12 levels, both when starting metformin and at intervals of no more than one to two years thereafter (note that the optimal frequency has not been determined, and metformin can begin to decrease serum B12 levels in as little as three months).6 A recent study showed that clinicians initially prescribing metformin measure vitamin B12 levels less than half the time.10 In this study of 5,131 patients with T2DM who started taking metformin during a 5-year study period (2008-2013), only 44.5% had vitamin B12 tested

Additionally, PPAR/ and ERR participate in positive feedback loops

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Due to our concerns regarding CPT code 78432 and the lack of an appropriate clinical APC for CPT codes 78431 and 78433 at this time based on resource cost similarity, we proposed to continue to assign CPT codes 78431 through 78433 to New Technology APCs for CY 2026