Imeglimin added to DPP-4i and MDI therapy significantly cut total insulin dosage in Type 2 Diabetes patients.

Managing Type 2 Diabetes (T2D) often involves multiple daily insulin injections (MDI), which can be complex and burdensome for patients. Simplifying MDI regimens while maintaining glycemic control is a significant clinical goal. While dipeptidyl peptidase-4 inhibitors (DPP-4i) are commonly used to enhance incretin effects, their combination with MDI and the novel oral antidiabetic drug imeglimin, particularly regarding insulin-reducing effects, remains underexplored. This study addresses the gap in understanding how imeglimin can impact insulin requirements in this specific patient population.

Researchers conducted a retrospective review of medical records from 30 inpatients with Type 2 Diabetes in Japan. All patients were receiving ongoing DPP-4i therapy and MDI, and subsequently had imeglimin 2,000 mg/day added to their regimen. Insulin dosage and self-monitoring blood glucose (SMBG) values were compared between baseline and 5 days after imeglimin initiation. Patients were categorized into bolus-discontinuation and bolus-continuation groups to analyze baseline characteristics and the correlation between bolus insulin reduction and other parameters.

After initiating imeglimin, patients experienced a significant reduction in total insulin dosage. Bolus insulin, specifically, was reduced by 10.6 ± 8.0 units/day. Concurrently, SMBG values showed improvement, with pre-breakfast and pre-dinner readings notably better. Despite a tendency for lower insulin secretory capacity in the bolus-continuation group, the reduction in total insulin (Δ insulin) and bolus insulin (Δ bolus) did not significantly differ between groups. No correlation was found between Δ bolus and baseline parameters such as BMI, duration of T2D, or insulin secretory capacity. This suggests the insulin-reducing effect was broad.

Adding imeglimin to DPP-4i therapy significantly reduced total insulin dosage, including 10.6 ± 8.0 units/day of bolus insulin, even in patients with low insulin secretory capacity.