Effect of GLP-1 Receptor (GLP-1R) Agonists on Cardiac Function and on Epicardial Adipose Tissue (EAT) Volume and on Myocardial TG Content in Obese Diabetics

Study Overview
=================
Brief Summary
-----------------
Glucagon-like peptide-1 (GLP-1) receptor agonist are new treatment of type 2 diabetes, they lower blood glucose level (by enhancement of glucose-dependent insulin secretion and suppression of excess glucagon secretion) and reduce weight by inducing satiety and slowing of gastric emptying. Beneficial effects of GLP-1 and GLP-1 receptor (GLP-1R) agonists on cardiovascular function have been suggested. They improve biomarkers of CV risk, decrease systolic blood pressure, improve endothelial function and have beneficial effects on myocardium. Nevertheless, few studies have analysed the effect of GLP1 treatment on myocardial function in type 2 obese diabetic. Myocardial steatosis is an independent predictor of diastolic dysfunction in type 2 diabetes mellitus. It was recently shown that 16 weeks of caloric restriction in obese patients with diabetes decrease myocardial triglyceride content and improve myocardial function (cardiac output, normalized stroke volume, LV mass and normalized end diastolic volume), and diastolic function. However, no study has evaluated the impact of Glucagon-like peptide-1 (GLP-1) receptor agonist in obese diabetics on myocardial TG content. Recent studies have suggested that increased epicardial adipose tissue (EAT) could be an important risk factor for cardiac diseases. We and others have already evidenced a correlation between the volume of epicardial adipose tissue and the presence or the severity of coronaropathy. The impact of weight loss on the volume of EAT or the characteristics of EAT is mostly unknown.

Official Title
-----------------
Effect of GLP-1 Receptor (GLP-1R) Agonists on Cardiac Function and on Epicardial Adipose Tissue (EAT) Volume and on Myocardial TG Content in Obese Diabetics

Conditions
-----------------
Obesity, Diabetes

Intervention / Treatment
-----------------
* Drug: BYETTA treatment
* Drug: Metformine


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: - Patients with type 2 diabetes according to WHO criteria Age> 18 years BMI ≥ 30 kg/m2 HbA1c> 7% and <10% Processing by ADO (Metformin and Glimepiride) Effective contraception (for women) Signed informed consent by the patient before inclusion in the protocol Exclusion Criteria: Ongoing pregnancy or become pregnant within six months of the study protocol Breastfeeding Recent weight loss (> 5% of total weight) Treatments changing the distribution of adipose tissue as corticosteroids or glitazones Acute coronary syndrome or unstable angina during the last three months Contraindications to cardiac MRI (mechanical heart valve, pacemaker, metallic intraocular foreign body, claustrophobia) Contraindication to cold test: Raynaud's syndrome Contraindication to exenatide: Neoplasia active or untreated or in remission for less than 5 years (except for basal cell carcinoma or in situ cervical or prostate) Contraindication to ADO (depending on specific product) in combination with exenatide. History of kidney transplant or dialysis or plasmatique creatinine> 1.5 mg / dL for men and> 1.2 mg / dL for women Digestive diseases, including gastroparesis plasma triglycerides> 1000 mg / dL History of pancreatitis confirmed biologically contraindication or hypersensitivity to Exenatide or one of its social coverage composantsAbsence

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: treatment BYETTA<br> | Drug: BYETTA treatment<br> <br> |
| Active Comparator: metformine<br> | Drug: Metformine<br> <br> |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| intracardiac triglyceride | Cardiac MRI | 3 years |