Effect of beta blocker use and type on hypoglycemia risk among hospitalized insulin requiring patients

Abstract

BackgroundAlthough beta blockers could increase the risk of hypoglycemia, the difference between subtypes on hypoglycemia and mortality have not been studied. This study sought to determine the relationship between type of beta blocker and incidence of hypoglycemia and mortality in hospitalized patients.MethodsWe retrospectively identified non-critically ill hospitalized insulin requiring patients who were undergoing bedside glucose monitoring and received either carvedilol or a selective beta blocker (metoprolol or atenolol). Patients receiving other beta blockers were excluded. Hypoglycemia was defined as any glucose < 3.9 mmol/L within 24 h of admission (Hypo1day) or throughout hospitalization (HypoT) and any glucose < 2.2 mmol/L throughout hospitalization (Hyposevere).ResultsThere were 1020 patients on carvedilol, 886 on selective beta blockers, and 10,216 on no beta blocker at admission. After controlling for other variables, the odds of Hypo1day, HypoT and Hyposevere were higher for carvedilol and selective beta blocker recipients than non-recipients, but only in basal insulin nonusers. The odds of Hypo1day (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.28, 3.09, p = 0.0002) and HypoT (OR 1.38, 95% CI 1.02, 1.86, p = 0.03) but not Hyposevere (OR 1.90, 95% CI 0.90, 4.02, p = 0.09) were greater for selective beta blocker vs. carvedilol recipients in basal insulin nonusers. Hypo1day, HypoT, and Hyposevere were all associated with increased mortality in adjusted models among non-beta blocker and selective beta blocker recipients, but not among carvedilol recipients.ConclusionsBeta blocker use is associated with increased odds of hypoglycemia among hospitalized patients not requiring basal insulin, and odds are greater for selective beta blockers than for carvedilol. The odds of hypoglycemia-associated mortality are increased with selective beta blocker use or nonusers but not in carvedilol users, warranting further study.

Carvedilol prevents impairment of the counterregulatory response in recurrently hypoglycaemic diabetic rats

“…A retrospective analysis was recently conducted on hospitalized diabetic patients who were taking beta‐blockers, either carvedilol or the selective beta‐blockers, metoprolol or atenolol, to examine whether the use of beta‐adrenergic blockers was associated with increased incidence of hypoglycaemia 49 . The study reported that diabetic patients who were not on basal insulin therapy had increased odds of hypoglycaemia and this ration was greater for the selective beta‐blockers compared to carvedilol.…”

The Neuroprotective Effect of Carvedilol on Diabetic Neuropathy: An In Vitro Study

“…However, there is minimal evidence for supporting the establishment that beta-blockers can be routinely contraindicated in diabetes since they have few clinically essential effects on hypoglycemia recovery and unawareness. Symptoms such as sweating might be improved even though some hypoglycemia signs including palpitation and tremor might be blunted [ 32 – 35 ]. The reason is that sweating is a sympathetic cholinergic reaction to hypoglycemia, which cannot be repressed by beta-blockers, and cautious use of beta-blockers improves sympathoadrenal activation by hypoglycemia.…”

The Association of Insulin-dextrose Treatment with Hypoglycemia in Patients with Hyperkalemia

“…There is an association between RAS blockers and hypoglycemia in patients with diabetes 27 , and between beta-blockers and hypoglycemia in hospitalized patients with diabetes acutely managed with insulin 28 . Betablockers reduce hepatic gluconeogenesis and reduce glycogenolysis but the mechanism of hypoglycemia with RAS blockers is unknown.…”