Effects of Exenatide on both fat mass loss and cardiometabolic risk in obese subjects with type 2 diabetes mellitus

Objective: The regulation of glucose and adipose tissue metabolism by GLP1-receptor agonist is a possible treatment of T2D and obesity. These new pharmacologic agents target insulin resistance and metabolic disorders. Methods: Eighteen patients, 7 males and 11 females, were studied with T2D, divided into two groups: the first (I) was poorly controlled by metformin and sulfonylureas; the second (II) was treated only with metformin. Exenatide was administered at an initial dose of 5 μg twice a day for one month, and then the dose was adjusted to 10 μg twice a day throughout 24-26 weeks. From the beginning of therapy, each group was analyzed at time 0 and at 1 month (T1) and then 6 months (T2). At every time, anthropometric data, body composition by DXA and biochemical parameters were recorded. Results: At baseline, all patients enrolled showed metabolic disorders and obesity. The comparison of both groups between baseline and T2 showed a significant decrease of body weight, total Fat Mass (FM) and HbA1c (%), only in group (I) a statical reduction of Glycaemia and Total Cholesterol was observed. The Free Fat Mass (FFM) was never seen significantly different. The patients with HbA1c levels >75 mmol/mol (9%) at baseline showed a greater decline of HbA1c when compared to the patients with HbA1c <75 mmol/mol. Conclusion: Exenatide improves glucose metabolism and total cholesterol levels. Moreover, Exenatide reduced total FM and did not affect FFM. Exenatide could be used to treat obesity in diabetic but also non-diabetic patients. Summary: Exenatide, a GLP1-receptor agonist, is a pharmacological agent against obesity and type 2 diabetes mellitus. Exenatide decreases insulin resistance and lipids metabolism, and could be able to reduce fat mass and cardiovascular risk.