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Pre-existing risk factors common in the diabetes population further compound concern: Older age (reduced intrinsic factor production) Autoimmune conditions (pernicious anaemia, thyroid disease) Previous gastric surgery or gastrointestinal disorders Vegetarian or vegan dietary patterns There is no established link between semaglutide pharmacology and B12 metabolism in the MHRA-approved product information, but the clinical context in which Ozempic is prescribed creates a population where B12 awareness is prudent

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Referral is also appropriate for severe anaemia, malabsorption disorders, or when the cause of deficiency remains unclear