Beta-Blockers Show Varied Effects on Hypoglycemic Mortality Risk in Diabetes

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Investigators examined the relationship between the use of β-blockers and incidence of hypoglycemia and risk for mortality in hospitalized patients with diabetes.
Investigators examined the relationship between the use of β-blockers and incidence of hypoglycemia and risk for mortality in hospitalized patients with diabetes.
The following article is part of conference coverage from the American Diabetes Association's 78th Scientific Sessions (ADA 2018) in Orlando,Florida. Endocrinology Advisor's staff will report on medical research and technological advances in diabetes and diabetes education, conducted by experts in the field. Check back for the latest news from ADA 2018.

ORLANDO — Among hospitalized basal insulin non-users, β-blocker use is associated with higher risk for hypoglycemia. And, regardless of β-blocker use, hypoglycemia is associated with increased hospital mortality. However, early hypoglycemia-associated mortality risk is reduced by β-blocker use. This research was recently presented at the American Diabetes Association's 78th Scientific Sessions, held June 22-26, 2018, in Orlando, Florida.

This study included 13,424 participants, 2648 of whom were administered β-blockers at the start of the study. Patients in this study were not in critical condition and had been receiving insulin subcutaneously for 2 years while being monitored for glucose levels. Hypoglycemia, classified as glucose levels below 70 mg/dL, was stratified into hypoglycemia in the first 24 hours of admission (hypo24), through the length of hospitalization (hypoT), or with glucose less than 40 mg/dL through the length of hospitalization (hypo40).

The likelihood of hypo24, hypoT, and hypo40 was greater for those who had received β-blockers (Hypo24 fully adjusted odds ratio [OR] 3.79; 95% CI, 3.21-4.50; P<.0001; HypoT fully adjusted OR 7.70; 95% CI, 6.77-8.77; P<.0001; Hypo40 OR 1.95; 95% CI 1.49-2.57; P<.0001). A higher likelihood of hypoT and hypo40 was associated with non-use of basal insulin but not with use. Hypo24, hypoT, and hypo40 all correlated with higher rates of mortality after adjustments. The use of β-blockers was associated with hypo24 and mortality, but this relationship did not persist at other points..  Mortality was increased among non-users vs β-blockers users.

The study researchers conclude that “[β-blocker] use is associated with higher risk of hypoglycemia in hospitalized basal insulin non-users, but not basal insulin users. Hypoglycemia is associated with increased hospital mortality, regardless of [β-blocker] use, but early hypoglycemia-associated mortality risk is attenuated by [β-blocker] use.”

Disclosures

J. Merrill: None. K.M. Dungan: Advisory Panel; Self; Sanofi-Aventis. Consultant; Self; GlaxoSmithKline plc.. Other Relationship; Self; DKBmed, Horizon, Projects in knowledge, Rockpointe. Research Support; Self; AstraZeneca, GlaxoSmithKline plc., Novo Nordisk Inc., Sanofi-Aventis.

For more coverage of ADA 2018, click here. 

Reference

Merrill J, Dungan KM. Beta-blocker usage and hypoglycemia in hospitalized patients with diabetes mellitus. Poster presentation at: 2018 ADA Scientific Sessions; June 22-26, 2018; Orlando, FL. Poster 382.

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