Insulin‐reducing effect of adding imeglimin to ongoing dipeptidyl peptidase‐4 inhibitor therapy with multiple daily insulin injections ( INSPIRE study)

INTRODUCTION: Simplifying multiple daily insulin injections (MDI) has attracted great interest in clinical practice. Although imeglimin shows good compatibility with dipeptidyl peptidase-4 inhibitors (DPP-4i), its effectiveness in patients treated with MDI remains unclear. This study aimed to investigate the real-world characteristics of such patients and the insulin-reducing effects of adding imeglimin to ongoing DPP-4i therapy. MATERIALS AND METHODS: Medical records of inpatients with type 2 diabetes (T2D) treated with imeglimin (2,000 mg/day) plus DPP-4i and MDI were reviewed. Insulin dosage and self-monitoring blood glucose (SMBG) values were compared between baseline and 5 days post-imeglimin initiation. Patients were divided into bolus-discontinuation (bolus insulin discontinued) and bolus-continuation (bolus insulin continued) groups, and baseline characteristics were compared. The correlation between the reduction in bolus insulin (Δ bolus) and baseline parameters was assessed. After imeglimin initiation, total insulin dosage decreased, with bolus insulin reduced by 10.6 ± 8.0 units/day. Pre-breakfast and pre-dinner SMBG values improved. Although insulin secretory capacity tended to be lower in the bolus-continuation group, Δ insulin and Δ bolus did not differ between groups. Δ bolus showed no correlation with baseline BMI, duration of T2D, or insulin secretory capacity. CONCLUSION: Adding imeglimin to DPP-4i significantly reduced insulin dosage, even in patients with low insulin secretory capacity. This combination may represent a useful therapeutic option for Japanese patients with T2D treated with MDI.