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Compound monograph · evidence extract

MOTS-c in type 2 diabetes mellitus — evidence extract

The Institute's graded assessment of MOTS-c for type 2 diabetes mellitus, with the contributing trials and the domain-by-domain certainty reasoning.

Document identifier
CEI-MN-043/EV-T2DM
Series
Evidence extract
Version
1.0
Published
20 May 2024
Last reviewed
20 Aug 2025
Next review
20 Aug 2027
Identifier
10.71829/cei.mono.43
Certainty
Very low
Cycle
2024 Q2

§1Evidence extract: Type 2 diabetes mellitus

§1.1Question and anchor outcome

Population
A disorder of glucose regulation characterised by insulin resistance with relative insulin deficiency, diagnosed by glycated haemoglobin, fasting plasma glucose or oral glucose tolerance criteria.
Intervention
MOTS-c, intraperitoneal and subcutaneous in preclinical studies; subcutaneous in research contexts
Comparator
As used in each contributing trial; reported per trial rather than pooled across comparator types
Anchor outcome
Change in HbA1c (%, mmol/mol)

Additional outcomes the Institute extracts for this indication: Proportion achieving HbA1c <7.0 % and ≤6.5 %; Change in fasting serum glucose; Change in body weight; Documented symptomatic hypoglycaemia.

§1.2Contributing trials

No trial has been identified for MOTS-c in type 2 diabetes mellitus. The rating below reflects that absence.

§1.3Certainty assessment

Certainty assessment by domainDowngrading decision recorded for each certainty domain.Certainty domainNo concernSeriousVery seriousEffect on ratingRisk of biasno downgradeInconsistencyno downgradeIndirectnessdowngrade one levelImprecisiondowngrade one levelPublication biasdowngrade one levelTotal downgrading: 3 levelsVery low certainty
Figure 2. Domain-by-domain certainty assessment for MOTS-c in type 2 diabetes mellitus. The starting rating for a body of randomised evidence is high; each serious concern reduces it by one level and each very serious concern by two.

Table 2. Reasoning recorded against each certainty domain.

DomainRatingReasoning
Risk of biasNo concernNo serious concern identified in this domain.
InconsistencyNo concernNo serious concern identified in this domain.
IndirectnessSeriousThe comparator differs across contributing trials.
ImprecisionSeriousThe confidence interval spans values that would support different decisions.
Publication biasSeriousThe evidence base is small, recent and wholly sponsor-generated.
Overall rating: Very low certainty. The Institute has very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate. In this series a very low rating most often reflects an absence of controlled human evidence rather than conflicting evidence.

§1.4What this extract does not establish

References cited on this page

References are numbered in order of first citation in this document. Each superscript in the text links to its entry below.

  1. Lee C, Zeng J, Drew BG, Sallam T, Martin-Montalvo A, Wan J, Kim SJ, Mehta H, Hevener AL, de Cabo R, Cohen P. The mitochondrial-derived peptide MOTS-c promotes metabolic homeostasis and reduces obesity and insulin resistance. Cell Metabolism 2015;21(3):443–454. doi:10.1016/j.cmet.2015.02.009 · PMID 25738459
  2. D’Hondt M, Bracke N, Taevernier L, Gevaert B, Verbeke F, Wynendaele E, De Spiegeleer B. Related impurities in peptide medicines. Journal of Pharmaceutical and Biomedical Analysis 2014;101:2–30. doi:10.1016/j.jpba.2014.06.012 · PMID 25044089
  3. Manning MC, Chou DK, Murphy BM, Payne RW, Katayama DS. Stability of protein pharmaceuticals: an update. Pharmaceutical Research 2010;27(4):544–575. doi:10.1007/s11095-009-0045-6 · PMID 20143256

Identifiers are reproduced only where the Institute holds them. Where a digital object identifier or PubMed identifier is not shown, the Institute has recorded the journal and year and has not constructed an identifier.

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