Imeglimin, a novel, first in-class, blood glucose-lowering agent: a systematic review and meta-analysis of clinical evidence


  • Thomas SJ Crabtree Sandwell and West Birmingham Hospitals NHS Trust University of Nottingham University of Derby and Burton NHS Trust
  • Ralph A DeFronzo University of Texas Health Science Center, San Antonio, Texas, USA
  • Robert E J Ryder City Hospital, Birmingham, UK
  • Clifford J Bailey Life and Health Sciences, Aston University, Birmingham, UK



type 2 diabetes, mitochondria, imeglimin, glimins, tetrahydrotriazine, systematic review, meta-analysis


Imeglimin is a novel, first in-class, blood glucose-lowering agent which acts via a mitochondrial mechanism to enhance glucose-induced insulin secretion, decrease hepatic glucose output and increase glucose uptake by skeletal muscle. A systematic review and meta-analysis of randomised controlled clinical trials (RCTs) with imeglimin in adults with type 2 diabetes was undertaken. Of 45 articles identified, five were RCTs but, due to the format of the data, only three could be combined in a meta-analysis (total n=180 participants). A random-effects model found that imeglimin 1500 mg twice daily as monotherapy and add-on to metformin or sitagliptin was associated with reductions of HbA1c by −0.63% (95% CI −0.84 to −0.42) (−6.6 mmol/mol, 95% CI −8.8 to −4.4) and reductions of fasting plasma glucose by −0.52 mmol/L (95% CI −0.80 to −0.24) compared with placebo. Adverse events were minimal, mostly gastrointestinal, and without hypoglycaemia. It is concluded that imeglimin displays promising improvements in HbA1c and fasting plasma glucose and is generally well tolerated.


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