Imeglimin therapy sustains glycemic control and improves insulin secretion in Japanese Type 2 Diabetes patients over 12 months

Effective long-term management of Type 2 Diabetes Mellitus (T2DM) requires agents that not only improve glycemic control but also preserve or enhance endogenous insulin function. Imeglimin, a first-in-class oral antidiabetic agent, uniquely targets both insulin secretion and insulin sensitivity. While its acute effects are known, real-world data on its sustained metabolic impact, particularly on the body's own insulin production over extended periods, has been limited. This study addresses the gap by evaluating Imeglimin's long-term efficacy and its influence on an insulin secretion index in routine clinical practice.

This retrospective observational study tracked 73 Japanese patients diagnosed with Type 2 Diabetes Mellitus who consistently received Imeglimin therapy for approximately 12 months. Researchers assessed changes in glycemic markers, specifically Hemoglobin A1c (HbA1c) and glycated albumin (GA), at baseline and throughout the follow-up period. Fasting plasma glucose and C-peptide levels, collected between 10 and 14 months post-initiation, were utilized to calculate the fasting C-peptide index (fCPI). The overall intensity of glucose-lowering treatment was quantified using the medication effect score (MES) to account for concomitant therapy adjustments.

Over 12 months, Imeglimin therapy led to a significant and sustained improvement in glycemic control. HbA1c levels notably decreased from a baseline of 8.55% ± 1.38% to 7.67% ± 0.99% (p < 0.0001). Similarly, glycated albumin (GA) showed a decline starting from the early phase of treatment. Crucially, the fasting C-peptide index (fCPI), an indicator of endogenous insulin secretion, increased from 1.14 [0.65-1.84] to 1.21 [0.79-2.01] (n=69, p=0.003), with an early increase observed within 1-2 months of initiation. This suggests an enhancement in pancreatic beta-cell function. Despite frequent adjustments to background antidiabetic therapies, the overall treatment intensity, as measured by the medication effect score (MES), did not change significantly, indicating that the glycemic improvements were primarily attributable to Imeglimin rather than an escalation of other medications.

HbA1c significantly decreased from 8.55% ± 1.38% to 7.67% ± 0.99% over 12 months (p < 0.0001), demonstrating sustained glycemic improvement.