Exenatide alters myocardial glucose transport and uptake depending on insulin resistance and increases myocardial blood flow in patients with type 2 diabetes

M. Gejl, H. M. Søndergaard, C. Stecher, B. M. Bibby, N. Møller, H. E. Bøtker, S. B. Hansen, A. Gjedde, Jørgen Rungby, B. Brock

Research output: Contribution to journalArticle

Abstract

Context: Glucagon-like peptide-1 (GLP-1) and GLP-1 receptor agonists provide beneficial cardiovascular effects by protecting against ischemia and reperfusion injury. Type 2 diabetes mellitus patients have reduced glycolysis in the heart. Objective: We hypothesized that cardioprotection by GLP-1 is achieved through increased glucose availability and utilization and aimed to assess the effect of exenatide, a synthetic GLP-1 receptor agonist, on myocardial glucose uptake (MGU), myocardial glucose transport, and myocardial blood flow (MBF). Design and Methods: We conducted a randomized, double-blinded, placebo-controlled crossover study in eight male, insulin-naive, type 2 diabetes mellitus patients without coronary artery disease. Positron emission tomography was used to determine the effect of exenatide on MGU and MBF during a pituitary-pancreatic hyperglycemic clamp with 18F-fluorodeoxyglucose and 13N-ammonia as tracers. Results: Overall, exenatide did not alter MGU. However, regression analysis revealed that exenatide altered initial clearance of glucose over the membrane of cardiomyocytes and MGU, depending on the level of insulin resistance (P±0.017 and 0.010, respectively). Exenatide increased MBF from 0.73 ± 0.094 to 0.85 ± 0.091 ml/g ± min (P ± 0.0056). Except for an increase in C-peptide levels, no differences in circulating hormones or metabolites were found. Conclusions: The action of exenatide as an activator or inhibitor of the glucose transport and glucose uptake in cardiomyocytes is dependentonbaseline activity of glucose transport and insulin resistance. Exenatide increases MBF without changing MGU.

Original languageEnglish (US)
JournalJournal of Clinical Endocrinology and Metabolism
Volume97
Issue number7
DOIs
StatePublished - Jul 2012
Externally publishedYes

Fingerprint

Medical problems
Type 2 Diabetes Mellitus
Insulin Resistance
Blood
Insulin
Glucose
Glucagon-Like Peptide 1
Cardiac Myocytes
exenatide
Positron emission tomography
C-Peptide
Fluorodeoxyglucose F18
Clamping devices
Glycolysis
Metabolites
Reperfusion Injury
Ammonia
Regression analysis
Positron-Emission Tomography
Cross-Over Studies

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Exenatide alters myocardial glucose transport and uptake depending on insulin resistance and increases myocardial blood flow in patients with type 2 diabetes. / Gejl, M.; Søndergaard, H. M.; Stecher, C.; Bibby, B. M.; Møller, N.; Bøtker, H. E.; Hansen, S. B.; Gjedde, A.; Rungby, Jørgen; Brock, B.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 97, No. 7, 07.2012.

Research output: Contribution to journalArticle

Gejl, M. ; Søndergaard, H. M. ; Stecher, C. ; Bibby, B. M. ; Møller, N. ; Bøtker, H. E. ; Hansen, S. B. ; Gjedde, A. ; Rungby, Jørgen ; Brock, B. / Exenatide alters myocardial glucose transport and uptake depending on insulin resistance and increases myocardial blood flow in patients with type 2 diabetes. In: Journal of Clinical Endocrinology and Metabolism. 2012 ; Vol. 97, No. 7.
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abstract = "Context: Glucagon-like peptide-1 (GLP-1) and GLP-1 receptor agonists provide beneficial cardiovascular effects by protecting against ischemia and reperfusion injury. Type 2 diabetes mellitus patients have reduced glycolysis in the heart. Objective: We hypothesized that cardioprotection by GLP-1 is achieved through increased glucose availability and utilization and aimed to assess the effect of exenatide, a synthetic GLP-1 receptor agonist, on myocardial glucose uptake (MGU), myocardial glucose transport, and myocardial blood flow (MBF). Design and Methods: We conducted a randomized, double-blinded, placebo-controlled crossover study in eight male, insulin-naive, type 2 diabetes mellitus patients without coronary artery disease. Positron emission tomography was used to determine the effect of exenatide on MGU and MBF during a pituitary-pancreatic hyperglycemic clamp with 18F-fluorodeoxyglucose and 13N-ammonia as tracers. Results: Overall, exenatide did not alter MGU. However, regression analysis revealed that exenatide altered initial clearance of glucose over the membrane of cardiomyocytes and MGU, depending on the level of insulin resistance (P±0.017 and 0.010, respectively). Exenatide increased MBF from 0.73 ± 0.094 to 0.85 ± 0.091 ml/g ± min (P ± 0.0056). Except for an increase in C-peptide levels, no differences in circulating hormones or metabolites were found. Conclusions: The action of exenatide as an activator or inhibitor of the glucose transport and glucose uptake in cardiomyocytes is dependentonbaseline activity of glucose transport and insulin resistance. Exenatide increases MBF without changing MGU.",
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T1 - Exenatide alters myocardial glucose transport and uptake depending on insulin resistance and increases myocardial blood flow in patients with type 2 diabetes

AU - Gejl, M.

AU - Søndergaard, H. M.

AU - Stecher, C.

AU - Bibby, B. M.

AU - Møller, N.

AU - Bøtker, H. E.

AU - Hansen, S. B.

AU - Gjedde, A.

AU - Rungby, Jørgen

AU - Brock, B.

PY - 2012/7

Y1 - 2012/7

N2 - Context: Glucagon-like peptide-1 (GLP-1) and GLP-1 receptor agonists provide beneficial cardiovascular effects by protecting against ischemia and reperfusion injury. Type 2 diabetes mellitus patients have reduced glycolysis in the heart. Objective: We hypothesized that cardioprotection by GLP-1 is achieved through increased glucose availability and utilization and aimed to assess the effect of exenatide, a synthetic GLP-1 receptor agonist, on myocardial glucose uptake (MGU), myocardial glucose transport, and myocardial blood flow (MBF). Design and Methods: We conducted a randomized, double-blinded, placebo-controlled crossover study in eight male, insulin-naive, type 2 diabetes mellitus patients without coronary artery disease. Positron emission tomography was used to determine the effect of exenatide on MGU and MBF during a pituitary-pancreatic hyperglycemic clamp with 18F-fluorodeoxyglucose and 13N-ammonia as tracers. Results: Overall, exenatide did not alter MGU. However, regression analysis revealed that exenatide altered initial clearance of glucose over the membrane of cardiomyocytes and MGU, depending on the level of insulin resistance (P±0.017 and 0.010, respectively). Exenatide increased MBF from 0.73 ± 0.094 to 0.85 ± 0.091 ml/g ± min (P ± 0.0056). Except for an increase in C-peptide levels, no differences in circulating hormones or metabolites were found. Conclusions: The action of exenatide as an activator or inhibitor of the glucose transport and glucose uptake in cardiomyocytes is dependentonbaseline activity of glucose transport and insulin resistance. Exenatide increases MBF without changing MGU.

AB - Context: Glucagon-like peptide-1 (GLP-1) and GLP-1 receptor agonists provide beneficial cardiovascular effects by protecting against ischemia and reperfusion injury. Type 2 diabetes mellitus patients have reduced glycolysis in the heart. Objective: We hypothesized that cardioprotection by GLP-1 is achieved through increased glucose availability and utilization and aimed to assess the effect of exenatide, a synthetic GLP-1 receptor agonist, on myocardial glucose uptake (MGU), myocardial glucose transport, and myocardial blood flow (MBF). Design and Methods: We conducted a randomized, double-blinded, placebo-controlled crossover study in eight male, insulin-naive, type 2 diabetes mellitus patients without coronary artery disease. Positron emission tomography was used to determine the effect of exenatide on MGU and MBF during a pituitary-pancreatic hyperglycemic clamp with 18F-fluorodeoxyglucose and 13N-ammonia as tracers. Results: Overall, exenatide did not alter MGU. However, regression analysis revealed that exenatide altered initial clearance of glucose over the membrane of cardiomyocytes and MGU, depending on the level of insulin resistance (P±0.017 and 0.010, respectively). Exenatide increased MBF from 0.73 ± 0.094 to 0.85 ± 0.091 ml/g ± min (P ± 0.0056). Except for an increase in C-peptide levels, no differences in circulating hormones or metabolites were found. Conclusions: The action of exenatide as an activator or inhibitor of the glucose transport and glucose uptake in cardiomyocytes is dependentonbaseline activity of glucose transport and insulin resistance. Exenatide increases MBF without changing MGU.

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DO - 10.1210/jc.2011-3456

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JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

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