Two Concerns and A Single Solution in Managing Type 2 Diabetes: A Narrative Review on Imeglimin

Type 2 diabetes (T2D) presents a formidable challenge to healthcare, with rising prevalence and complex pathogenesis involving beta-cell dysfunction and insulin resistance. Imeglimin, the progenitor of the "glimins" class, emerges as a multifaceted agent capable of attenuating beta-cell apoptosis, reducing hepatic gluconeogenesis, and augmenting muscular glucose uptake. This positions it as a promising solution for T2D management, especially for patients inadequately controlled by current therapies. This narrative review delves into the potential of imeglimin to address the mitochondrial dysfunctions central to T2D pathology, offering insights into its distinct mechanism that leverages the modulation of mitochondrial bioenergetics to enhance insulin sensitivity and reduce oxidative stress. The Trials of Imeglimin for Efficacy and Safety (TIMES) program, consisting of multiple clinical trials, has substantiated the efficacy and safety of imeglimin, illustrating significant glycated hemoglobin (HbA1c) reductions and favorable safety profiles. This review synthesizes evidence from these trials, providing a comprehensive overview of imeglimin as a novel monotherapy and its compatibility in combination therapies, heralding a novel approach to T2D treatment that targets the disease's mitochondrial roots.