The objective of the study is to assess the impact of Exenatide on endothelial reactivity, and change in ectopic fat and cardiac function. This study included 44 patients (mean 52 years) randomized to Exenatide or reference treatment. Magnetic resonance imaging was used to assess ectopic fat accumulation, coronary vasoreactivity and cardiac function. 16-weeks of Exenatide treatement resulted in a significant improvement in glycemic control and a significant reduction of both epicardial fat and hepatic steatosis. However, we found no effect of Exenatide on myocardial function. In addition, one-week of exenatide treatment had only a modest effect on vascular reactivity, albeit non-significant.