Efficacy of imeglimin in patients with type 2 diabetes mellitus complicated by metabolic dysfunction‐associated steatotic liver disease: A multicentre study

Abstract Aims This study aimed to evaluate the effectiveness of imeglimin in improving liver function and fibrosis in patients with type 2 diabetes (T2D) complicated by metabolic dysfunction‐associated steatotic liver disease (MASLD). Materials and Methods We conducted a multicentre study involving 80 patients with T2D and MASLD who were treated with or without imeglimin for 24 weeks. We assessed the changes in diabetes‐related parameters, including HbA1c, fasting blood glucose, glycoalbumin and C‐peptide index. Liver function was monitored using AST, ALT, γ‐GTP and liver fibrosis indicators such as Fib‐4 index and FibroScan‐AST (FAST) score. Liver fat content and stiffness were measured using controlled attenuation parameter and vibration‐controlled transient elastography, which were measured using FibroScan. Results Compared with the control group, imeglimin treatment led to a significant reduction in HbA1c levels, fasting blood glucose and liver‐related parameters, including AST, ALT and γ‐GTP. Additionally, the Fib‐4 index and FAST score, which reflect liver fibrosis and inflammation, were significantly lower in the imeglimin group. Liver fat content and stiffness remained unchanged during the study period. Conclusions Imeglimin efficaciously improved liver inflammation and fibrosis in patients with T2D and MASLD, with no significant changes in liver fat content or stiffness. These findings suggest that imeglimin is a promising therapeutic drug for the management of MASLD in the context of T2D, warranting further research on its long‐term efficacy and mechanisms of action.