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Published research from MedStar investigators has found the potential for exenatide to possibly reduce the risk of heart attack and stroke in patients with type-1 diabetes in a small study. Exenatide is a glucagon-like peptide 1 analogue (GLP-1), a class of drugs that has been shown to favorably affect the risk for heart disease in patients with type 2 diabetes but its role in patients with type 1 diabetes is unknown. Led by Evgenia A. Gourgari, MD, the research team included Mihriye Mete, PhD; Maureen L. Sampson; Alan T. Remaley, MD, PhD; and Kristina I. Rother, MD, MHSc.
The research published in Diabetes Care, “Exenatide Improves HDL Particle Counts and Size Distribution in Patients With Long-standing Type 1 Diabetes”, was an ancillary study of a previously published clinical trial. In the initial study, over 6 months, participants were randomized to receive medication (exenatide) to treat their type-1 diabetes in either alone or in tandem with other medications (daclizumab). Participants also received nutritional counseling.
The 14 study participants were 50% female vs male, with an average age of 37, living with type-1 diabetes for more than 20 years. A total of 11 of 14 patients were on statin treatment. People who have naturally higher levels of HDL cholesterol are at lower risk of heart attacks and stroke.
“Our study shows that exenatide treatment increased total fasting non-HDL cholesterol, fasting large HDL particles (HDLp), and postprandial large and medium HDLp. This finding is important given that large, lipid-enriched HDLp are associated with a decreased cardiovascular disease risk compared with small HDLp,” the authors found. They noted that while some of the decreased risk could have been associated with weight loss, other studies have shown that even a single dose of exenatide can improve postprandial lipids in patients with type 2 diabetes, regardless of weight loss.
“Our preliminary results suggest that exenatide might improve cardiovascular outcomes in patients with type 1 diabetes by improving large HDLp,” the authors concluded. Future studies can seek to validate these results in a larger group and further examine the biological effects of exenatide on HDL function.
Diabetes Care, 2017. DOI: 10.2337/dc16-2602