Type 2 diabetes (T2D) and
obesity represent entangled pandemics that accelerate the development of
cardiovascular disease (CVD). Given the immense burden of CVD in society, non-invasive prevention and treatment strategies to promote cardiovascular health are desperately needed. During T2D and
obesity, chronic dysglycemia and abnormal adiposity result in systemic oxidative stress and
inflammation that deplete the vascular regenerative cell reservoir in the bone marrow that impairs blood vessel repair and exacerbates the penetrance of CVD co-morbidities. This novel translational paradigm, termed 'regenerative cell exhaustion' (RCE), can be detected as the depletion and dysfunction of hematopoietic and endothelial progenitor cell lineages in the peripheral blood of individuals with established T2D and/or
obesity. The reversal of vascular RCE has been observed after administration of the
sodium-
glucose cotransporter-2 inhibitor (SGLT2i),
empagliflozin, or after
bariatric surgery for
severe obesity. In this review, we explore emerging evidence that links improved dysglycemia to a reduction in systemic oxidative stress and recovery of circulating pro-vascular progenitor cell content required for blood vessel repair. Given that
bariatric surgery consistently increases systemic
glucagon-like-peptide 1 (GLP-1) release, we also focus on evidence that the use of
GLP-1 receptor agonists (GLP-1RA) during
obesity may act to inhibit the progression of systemic dysglycemia and adiposity, and indirectly reduce
inflammation and oxidative stress, thereby limiting the impact of RCE. Therefore, therapeutic intervention with currently-available GLP-1RA may provide a less-invasive modality to reverse RCE, bolster vascular repair mechanisms, and improve cardiometabolic risk in individuals living with T2D and
obesity.