CLINICAL TRIAL article
Front. Endocrinol.
Sec. Clinical Diabetes
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1639046
This article is part of the Research TopicTranslational Potential of Novel Biomarkers and Molecular Targets in Lifestyle DisordersView all 4 articles
Imeglimin-Based Therapies Improve Glycemic Control and Reduce Mitochondrial Stress in Type 2 Diabetes: A Prospective Cohort Study
Provisionally accepted
- 1SRM Institute of Science and Technology, Chennai, India
- 2SRM Institute of Science and Technology (Deemed to be University) SRM Medical College Hospital and Research Centre, Kanchipuram, India
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Background: Imeglimin, a novel oral antidiabetic agent, has demonstrated mitochondrial and anti-inflammatory benefits. This study evaluated the efficacy of Imeglimin-based therapies on glycemic control, mitochondrial stress (circulating cell-free mitochondrial DNA (ccf-mtDNA), and inflammation in type 2 diabetes mellitus (T2DM). Methods: A total of 104 T2DM patients were enrolled and assigned to one of four groups out of which 96 patients completed follow-up and data was analyzed: Imeglimin monotherapy (n=23), Imeglimin + Metformin (n=24), Imeglimin + other Oral Hypoglycemic Agents (OHAs) (n=24), and Metformin + other OHAs (n=25). Assessments at baseline and 6 months included HbA1c, lipid profile, ccf-mtDNA, NOD-like receptor family, pyrin domain containing 3 (NLRP3), Interleukins-6, 1β and 18 (IL-6, IL-1β, and IL-18). Within-group changes were assessed using paired t-tests. Repeated measures ANCOVA models analyzed group-time interactions. Correlation analysis explored associations between Δ biomarkers and metabolic parameters. Results: Combination therapies, particularly Imeglimin + other OHAs, significantly reduced HbA1c (Δ = –0.5%, p = 0.001), ccf-mtDNA (Δ = –18.5 copies/μL, p = 0.02), and IL-6 (p < 0.001). Repeated measures ANCOVA revealed significant reductions in HbA1c (p=0.001), circulating cell-free mtDNA (p=0.004), and serum NLRP3 levels (p=0.037) across imeglimin-based therapy groups. Post hoc comparisons showed the greatest improvements in the Imeglimin + Other OHAs group versus control. Significant time × group effects for IL-6 and IL-1β. No changes were noted in IL-18. Conclusion: Imeglimin, especially in combination with non-Metformin OHAs, improves glycemic control and reduces mitochondrial and inflammatory stress in T2DM patients. These findings support its use as an adjunctive therapy with broader metabolic benefits.
Keywords: Imeglimin, type 2 diabetes mellitus, ccf-mtDNA, NLRP3 inflammasome, HbA1c, Oral hypoglycemic agents
Received: 15 Jun 2025; Accepted: 02 Sep 2025.
Copyright: © 2025 Satheesan, Kumar, Vajravelu and Murugesan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Abhishek Satheesan, SRM Institute of Science and Technology, Chennai, India
Janardanan Subramonia Kumar, SRM Institute of Science and Technology (Deemed to be University) SRM Medical College Hospital and Research Centre, Kanchipuram, India
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