They do know the mechanism by which metformin causes B12 deficiency and diet alone will not stop it or resolve it.
Metformin disrupts the intrinsic factors necessary for the body to use B12 from food, most notably the role of calcium in the process. That's why it's necessary for calcium to be taken along with oral supplements.
B12 deficiency doesn't cause a low blood count, it's a megloblastic anemia which means that it changes the shape of the blood cells and prevents them from working efficienctly. It doesn't reduce the CBC until in the very late and dangerous stages when the nerve and organ damage is likely to be permanent. The two relaible methods of testing are looking for serum B12 in the blood, and looking at a sample of blood under a microscope to see if the blood cells are a normal size and shape. Neither are routine blood tests.
Diabetics taking metformin in the UK are not regularly tested for B12 deficiency and I've never yet found a GP who has been aware of the issue prior to my bringing it to their attention, despite it being documented in the BMJ.
Statictically 30% of metformin users will start to show signs of B12 deficiency after taking metformin for four years. The percentage goes up with patient age and with continued use of metformin. I was on metformin for seven years before I had any problems. In that time I had only one B12 test, at my request, and that was to prove that I was reacting to simvastatin and not B12 deficient after taking metformin for four years. At that point my results were in the lower range of normal despite a meat based diet. Vegetarians on metformin will always be more suseptible to B12 deficiency due to a lack of animal products in their diet.