A 42-year-old man with Type 2 diabetes mellitus on metformin monotherapy presents with a 3-month history of progressive fatigue, dyspnea on exertion, and a 4 kg weight loss. His HbA1c is 8.2%. Laboratory investigations reveal: serum creatinine 2.1 mg/dL (eGFR 28 mL/min/1.73 m²), hemoglobin 8.5 g/dL, and elevated reticulocyte count. Peripheral blood smear shows macrocytic red blood cells. All of the following are true regarding the pathophysiology and management of his anemia EXCEPT:

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