Potential Ketoacidosis Linked to Imeglimin and Metformin Co-administration in a Patient With Type 2 Diabetes

A 74-year-old woman with type 2 diabetes mellitus developed ketoacidosis within six days of adding metformin to imeglimin treatment. The patient was insulin-sensitive and showed preserved insulin secretion; therefore, insufficiency alone unlikely contribute the development ketoacidosis. Both partially inhibit complex I in mitochondrial respiratory chain. Inhibition respiration can lead tricarboxylic acid (TCA) cycle suppression. Thus, entry acetyl-coenzyme into TCA is restricted, it eventually used ketogenesis. Therefore, combination might have precipitated