Improved HbA1c value by combined treatment of Dulaglutide and Imeglimin for patient with type 2 diabetes mellitus (T2DM)

Background: As a novel oral hypoglycemic agent (OHA), imeglimin has been recently applied for patients with type 2 diabetes mellitus (T2DM) as Twymeeg. It has beneficial twin mechanisms associated with increasing insulin secretion, and decreasing insulin resistance. It has a triazine ring and become the first OHA for tetrahydrotriazine-containing agent in the category of the glimins. Case presentation: The case is 84-year-old female with T2DM and mild cognitive impairment (MCI). Her HbA1c was 9.3% a year ago. Results: She was begun to receive Dulaglutide 0.75mg/week and showed 1.3% HbA1c reduction for 6 months. However, HbA1c was elevated again to 8.5%, and then she was provided Twymeeg 2000mg/day. HbA1c decreased from 8.5% to 7.5% in 3 months. [Discussion and conclusion] From combined treatments of imeglimin and other agents in the previous study, mean HbA1c reduction showed single imiglimin -0.46%, DPP-4i -0.92% and GLP-1RA -0.12%. Possible reason for the difference between the latter two suggests that multiple action mechanisms of imeglimin may be present including the enhancement of glucose-stimulated insulin secretion (GSIS). In contrast, she showed satisfactory HbA1c reduction by the combination of imeglimin and GLP-1RA. The pathophysiology is not clear, and future follow up the clinical progress will be required.