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Satisfactory Effect by Low Carbohydrate Diet (LCD) And Imeglimin (Twymeeg) for Diabetic Case with Fatty Liver and Lumbar Spinal Stenosis (LSS)
Author(s): Toshiharu Kobayashi1, Hiroshi Bando1,2iD*, Maki Okada1, Tomoya Ogawa1, Noboru Iwatsuki1
1Sakamoto Hospital, Higashi Kagawa city, Kagawa, Japan
2Tokushima University / Medical Research, Tokushima, Japan
Corresponding Author: Hiroshi Bando ORCiD
Address: Tokushima University /Medical Research, Nakashowa 1-61, Tokushima 770-0943, Japan.
Received date: 18 April 2026; Accepted date: 28 May 2026; Published date: 05 June 2026
Citation: Kobayashi T, Bando H, Okada M, Ogawa T, Iwatsuki N. Satisfactory Effect by Low Carbohydrate Diet (LCD) And Imeglimin (Twymeeg) for Diabetic Case with Fatty Liver and Lumbar Spinal Stenosis (LSS). Diab Res Open Access. 2026 Jun 05;7(1):09-13.
Copyright © 2026 Kobayashi T, Bando H, Okada M, Ogawa T, Iwatsuki N. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Keywords: Low-Carbohydrate Diet, Lumbar Spinal Stenosis, Imeglimin, Low Back Pain, Trials of IMeglimin for Efficacy and Safety
Abstract
The patient was a 56-year-old male with obesity, lumbar spinal stenosis (LSS), and type 2 diabetes (T2D). He was diagnosed with T2D in September 2025, with an HbA1c of 12.7% and a BMI of 34.4 kg/m². He began treatment with a low-carbohydrate diet (LCD), imeglimin (Twymeeg), and empagliflozin. HbA1c decreased to 6.4% within 5 months, accompanied by a 7-kg weight reduction and relief of low back pain (LBP). Blood biochemistry revealed remarkable improvements in AST, ALT, and GGT levels, with no gastrointestinal adverse effects (GI-AEs) associated with imeglimin. The satisfactory clinical improvement appeared to be attributable to multiple factors, including LCD, imeglimin, SGLT2 inhibitor therapy, and the patient's continued diligence in maintaining lifestyle modifications.
Abbreviations: ALT: Alanine Aminotransferase; AST: Aspartate Aminotransferase; BMI: Body Mass Index; GI-AE: Gastrointestinal Adverse Effect; GGT: Gamma-Glutamyl Transferase; HbA1c: Hemoglobin A1c; LBP: Low Back Pain; LCD: Low-Carbohydrate Diet; LSS: Lumbar Spinal Stenosis; SGLT2-i: Sodium-Glucose Cotransporter-2 Inhibitor; T2D: Type 2 Diabetes; TIMES: Trials of IMeglimin for Efficacy and Safety
Abstract
The patient was a 56-year-old male with obesity, lumbar spinal stenosis (LSS), and type 2 diabetes (T2D). He was diagnosed with T2D in September 2025, with an HbA1c of 12.7% and a BMI of 34.4 kg/m². He began treatment with a low-carbohydrate diet (LCD), imeglimin (Twymeeg), and empagliflozin. HbA1c decreased to 6.4% within 5 months, accompanied by a 7-kg weight reduction and relief of low back pain (LBP). Blood biochemistry revealed remarkable improvements in AST, ALT, and GGT levels, with no gastrointestinal adverse effects (GI-AEs) associated with imeglimin. The satisfactory clinical improvement appeared to be attributable to multiple factors, including LCD, imeglimin, SGLT2 inhibitor therapy, and the patient's continued diligence in maintaining lifestyle modifications.
Abbreviations: ALT: Alanine Aminotransferase; AST: Aspartate Aminotransferase; BMI: Body Mass Index; GI-AE: Gastrointestinal Adverse Effect; GGT: Gamma-Glutamyl Transferase; HbA1c: Hemoglobin A1c; LBP: Low Back Pain; LCD: Low-Carbohydrate Diet; LSS: Lumbar Spinal Stenosis; SGLT2-i: Sodium-Glucose Cotransporter-2 Inhibitor; T2D: Type 2 Diabetes; TIMES: Trials of IMeglimin for Efficacy and Safety
Abstract
The patient was a 56-year-old male with obesity, lumbar spinal stenosis (LSS), and type 2 diabetes (T2D). He was diagnosed with T2D in September 2025, with an HbA1c of 12.7% and a BMI of 34.4 kg/m². He began treatment with a low-carbohydrate diet (LCD), imeglimin (Twymeeg), and empagliflozin. HbA1c decreased to 6.4% within 5 months, accompanied by a 7-kg weight reduction and relief of low back pain (LBP). Blood biochemistry revealed remarkable improvements in AST, ALT, and GGT levels, with no gastrointestinal adverse effects (GI-AEs) associated with imeglimin. The satisfactory clinical improvement appeared to be attributable to multiple factors, including LCD, imeglimin, SGLT2 inhibitor therapy, and the patient's continued diligence in maintaining lifestyle modifications.