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Aims Materials and Methods Results Conclusions To compare the efficacy of adding imeglimin versus that of metformin dose escalation on glycemic control in subjects with type 2 diabetes treated with a dipeptidyl peptidase‐4 inhibitor plus low‐dose metformin (500–1000 mg/day).In this multicentre, open‐labelled, prospective, randomized, parallel‐group comparison study, the addition of imeglimin (2000 mg/day) or metformin escalation was applied for 24 weeks in eligible subjects. The primary endpoint was the mean change in glycated haemoglobin (HbA1c) over 24 weeks. As the secondary endpoints, the occurrence of adverse events, changes in metabolic parameters, biomarkers and factors associated with HbA1c improvement were analysed.Seventy‐three eligible subjects were enrolled. Of them, 65 participants comprised the full analysis set. At 24 weeks, the addition of imeglimin (n = 33) resulted in greater improvement in HbA1c compared with metformin dose escalation (n = 32) (from 7.61 ± 0.48% to 6.93 ± 0.49% in imeglimin and from 7.56 ± 0.61% to 7.09 ± 0.56% in metformin escalation; change difference: −0.21% [95% confidence interval: −0.41%, −0.01%] [p = 0.038]); however, seven subjects in the imeglimin group discontinued imeglimin because of serious adverse events on gastrointestinal tract. In intra‐group pre/post comparisons, imeglimin treatment significantly reduced body weight and improved liver enzyme elevation. There was a significant correlation between improvement levels of HbA1c and indicators of fatty liver disease in the imeglimin group.Imeglimin in combination with a dipeptidyl peptidase‐4 inhibitor and low‐dose metformin improved HbA1c compared with metformin dose escalation. [ABSTRACT FROM AUTHOR]

This article discusses a comparative study that examines the effects of imeglimin add-on therapy and metformin dose escalation on glycaemic variability in individuals with type 2 diabetes. The study found that while both treatments resulted in a decrease in mean blood glucose levels, only imeglimin add-on therapy significantly reduced measures of glycaemic variability, such as mean amplitude of glycaemic excursions (MAGE), coefficient of variation (CV), and standard deviation (SD). The study suggests that imeglimin may be effective in suppressing glucose spikes and improving glycaemic control in individuals with type 2 diabetes. [Extracted from the article]