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A study conducted using a rat model of type 1 diabetes demonstrated reduced inflammatory cell infiltration and decreased glomerular expression of inflammatory markers, including TGF-1 and intercellular adhesion molecule-1, with administration of exendin-4 [51]

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Hence they stimulate the accumulation of lipid intermediate metabolites [lysophosphatidic acid (LPA), diacylglycerol (DAG), acylcarnitines and ceramides], which promote defects of the insulin signaling pathway, exacerbate IR and stimulate several signaling pathways related to inflammation and oxidative stress, creating a second vicious-cycle of a feed-forward effect [17, 2123]