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Check vitamin B12 levels in people treated with metformin who have symptoms suggestive of vitamin B12 deficiency This will also include patients found to have megaloblastic anaemia (raised mean corpuscular volume [MVC]), who may be asymptomatic (MHRA, 2022)

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Acknowledgements We thank Anna Altin, Tamara Grossrieder, Arne Hansen, Samanda Krasniqi, Marina Reist, Melanie Schulz and Jelena Velimirovic, for their help in data acquisition, and Samuel Gerster for technical support

Therefore, drugs that affect BBB permeability represent potentially interesting strategies in neurodegenerative diseases

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