Beta-Blockers Show Varied Effects on Hypoglycemic Mortality Risk in Diabetes
Investigators examined the relationship between the use of β-blockers and incidence of hypoglycemia and risk for mortality in hospitalized patients with diabetes.
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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.”
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.
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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.