Clinical significance of imeglimin in older patients with type 2 diabetes: Analysis of a national database and a long-term case suggesting the potential for sarcopenia prevention

We aimed to evaluate the clinical significance of imeglimin in older patients with type 2 diabetes. Prescription trends were analyzed using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (2021-2023). Prescriptions for imeglimin increased, with the highest usage among patients in their 70s, followed by those in their 60s, and a clear upward trend in those aged ≥ 80 years. We present the case of an 80-year-old woman with diabetes who repeatedly discontinued treatment. After initiating imeglimin (2000 mg/day), she continued therapy successfully, achieving stable HbA1c levels at approximately 7% over 30 months. Muscle mass indices (creatine kinase, creatinine, and estimated glomerular filtration rate), nutritional status (albumin), and inflammation (C-reactive protein) remained stable, and independent walking and quality of life were preserved. These findings suggest that imeglimin may support glycemic control and may help attenuate frailty and sarcopenia progression in older adults with diabetes.