Imeglimin in Type 2 Diabetes Mellitus: Expert Opinions and Consensus in Indian Context

The morbidity of type 2 diabetes mellitus (T2DM) is rising dramatically both at the national and international levels. In recent years, many novel medications are developed or in development for better management of hyperglycemia in people with T2DM. Focusing on the new promising molecules, here we aim to present the opinion of experts and their consensus on the use of imeglimin for the treatment of T2DM in India.

Multiple advisory board meetings were conducted with six leading key opinion leaders (KOLs) in endocrinology and diabetes specialty across India to share their experiences, understand and discuss the real-world imeglimin treatment strategies, its effectiveness and safety in patients with T2DM.

A novel oral antidiabetic drug (ADD), imeglimin, a tetrahydrotriazine compound of the "glimin" family, is currently being used in the treatment of T2DM. Its mode of action is unique when compared to other types of ADDs as it has a dual mode of action, which includes (1) improving the action of insulin and (2) reversing pancreatic β-cell dysfunction. Additionally, imeglimin has been associated with reduced hepatic steatosis, protection from β-cell apoptosis and stimulation of skeletal muscle glucose absorption. Efficacy and safety of imeglimin as a monotherapy is well demonstrated in treatment-naive patients when metformin is contraindicated or in patients who are intolerant to metformin, metformin failure, or as an add-on/combination with other oral antidiabetic drugs (OADs), mainly DPP4i, SGLT2i or insulin. The clinical efficacy of imeglimin is dose dependent, and it is observed that the efficacy of imeglimin 1,000 mg BID is >500 mg BID.

This consensus paper presents the experts' opinion of their real-world clinical experiences on imeglimin treatment, its clinical efficacy, safety and their recommendations for better management of T2DM.