Evidence mapPaperPMID 41661272Full record

ArticleActa diabetologica2026

Effect of metformin dose reduction versus continuation at imeglimin initiation on glycemic control in type 2 diabetes: a retrospective real-world analysis.

Yoshiro Fushimi, Tomohiko Kimura, Junpei Sanada, Takashi Ito, Masato Kubo, Kazunori Dan, Yui Okamoto, Hideyuki Iwamoto, Yuichiro Iwamoto, Masashi Shimoda and 3 more

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Article in Acta diabetologica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Repurposing metformin for choriocarcinoma: targeting the AMPK/mTOR pathway.Naunyn-Schmiedeberg's archives of pharmacology · 2026
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Yoshiro FushimiDepartment of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan. fussy.k0113@med.kawasaki-m.ac.jp.ORCID http://orcid.org/0000-0002-9618-8698
Tomohiko KimuraDepartment of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
Junpei SanadaDepartment of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
Takashi ItoDepartment of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
Masato KuboDepartment of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
Kazunori DanDepartment of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
Yui OkamotoDepartment of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
Hideyuki IwamotoDepartment of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
Yuichiro IwamotoDepartment of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
Masashi ShimodaDepartment of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
Shuhei NakanishiDepartment of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
Kohei KakuDepartment of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
Hideaki KanetoDepartment of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsTo evaluate whether continuing versus reducing metformin at imeglimin initiation is associated with 24-week changes in HbA1c and body weight in routine practice, and to describe 48-week outcomes.

methodsSingle-center retrospective study of adults with type 2 diabetes who started imeglimin 2000 mg/day (September 2022-August 2024). For the primary 24-week efficacy analysis, metformin users who tolerated and continued imeglimin through week 24 were classified as metformin continuation (no change) or metformin reduction (≥ 250 mg/day decrease, including discontinuation). The primary endpoint was 24-week ΔHbA1c. Associations were assessed with nonparametric tests and ANCOVA adjusting for age, sex, diabetes duration, and baseline HbA1c; sensitivity models additionally adjusted for baseline metformin dose and major concomitant glucose-lowering drug classes (SGLT2i, GLP-1RA, insulin, and sulfonylureas).

resultsSeventy metformin users were included (continuation n = 34; reduction n = 36). At 24 weeks, HbA1c decreased by - 0.6% versus - 0.2% (median difference - 0.5%, 95% CI - 0.6 to - 0.3), and body weight by - 1.2 kg versus - 0.4 kg (median difference - 0.9 kg). The absolute metformin dose reduction correlated with ΔHbA1c (Spearman ρ = 0.52). Metformin continuation remained associated with greater adjusted HbA1c reduction in sensitivity ANCOVA (adjusted difference - 0.57%, 95% CI - 0.88 to - 0.26; P = 0.0006). In a 48-week cohort (n = 65) continuing imeglimin, metformin dose reduction remained associated with ΔHbA1c in multivariable analysis.

conclusionsContinuing metformin at imeglimin initiation was associated with greater improvements in HbA1c and body weight than dose reduction. Findings are associative and may reflect residual confounding.

Indexed as

Diabetes Mellitus, Type 2Hypoglycemic AgentsMetforminAgedBlood GlucoseBody WeightFemaleGlycated HemoglobinGlycemic ControlHumansMaleMiddle AgedRetrospective StudiesTriazinesBlood GlucoseGlycated Hemoglobinhemoglobin A1c protein, humanHypoglycemic AgentsimegliminMetforminTriazinesDose adjustmentGlycemic controlImegliminMetforminReal-world studyType 2 diabetes

Identifiers

PMID41661272

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.