Effects of exenatide on microvascular reactivity in patients with type 2 diabetes and coronary artery disease, a randomized controlled study.

OBJECTIVE We studied the effect of the glucagon-like peptide-1 receptor agonist (GLP-1RA) exenatide on skin microvascular function in patients with type 2 diabetes (T2DM) and coronary artery disease (CAD). METHODS Thirty-five patients with T2DM, CAD and glycated hemoglobin (HbA1C) 42-86 mmol/mol were randomised to treatment with exenatide or conventional non-GLP-1 based therapy for 12 weeks. Skin microvascular function was examined in the forearm by laser Doppler fluxmetry and iontophoretic application of acetyl choline and sodium nitroprusside, and by post occlusive reactive hyperaemia (PORH) at baseline and after 12 weeks. Blood samples for fasting plasma glucose, HbA1C and lipid profile were collected. RESULTS At 12 weeks, patients on exenatide showed reductions in HbA1C (from 63.5 ±13 to 60.7 ±14 mmol/mol, P=0.065), body weight (from 92.6 ±16 to 89 ±16 kg, P<0.001) and systolic blood pressure (from 141 ±13 to 134 ±16 mmHg, P<0.05) as compared to the conventionally treated group. There were no significant changes in skin microvascular function between or within the two groups at follow-up. CONCLUSIONS Three months daily treatment with the GLP-1RA exenatide in T2DM patients with CAD showed no significant effects on skin microvascular function or blood glucose control, while this study confirms a reduction in body weight and blood pressure by exenatide, as compared to conventional antidiabetic drug treatment.