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Not every GP routinely tests vitamin B12 levels in post-bariatric patients, and not every post-bariatric patient attends regular follow-up appointments

You take medications known to interfere with B12 absorption, including metformin, proton pump inhibitors, or H2 receptor antagonists

It's about verifying assumptions before they become permanent concentration errors

We dont know how stable they are

Disclaimer: *These statements have not been evaluated by the Food and Drug Administration

From a laboratory medicine perspective, the Association for Clinical Biochemistry and Laboratory Medicine (ACB) and the Royal College of Pathologists (RCPath) advise that: HbA1c may be unreliable in the presence of haemolytic anaemia, haemoglobinopathies, or nutritional deficiencies affecting red cell biology and the direction of distortion may be high or low Clinicians should document any known haematological conditions when requesting HbA1c, so laboratory staff can flag potential inaccuracies Serum B12 testing should be considered in patients on long-term metformin who are symptomatic or have risk factors for deficiency, in line with MHRA and NICE advice Alternative tests fasting plasma glucose, OGTT, or interim use of fructosamine/glycated albumin should be considered when HbA1c reliability is in doubt The NHS website (nhs.uk) provides patient-facing information on the HbA1c test and factors that can affect its accuracy, which patients may find a useful starting point