Abstract
BackgroundThe prognostic benefits of beta-blockers (BB) in patients with systolic heart failure (SHF) are known but despite this, in patients with diabetes they are underutilized. The aim of this study was to assess the effect of beta-blockers (BB) on glycaemic control in patients with Type 2 Diabetes (T2DM) and systolic heart failure (SHF) stratified to beta-1 selective (Bisoprolol) vs. nonselective BB (Carvedilol).MethodsThis observational, cohort study was conducted in patients with T2DM and SHF attending an Australian tertiary teaching hospital's heart failure services. The primary endpoint was glycaemic control measured by glycosylated haemoglobin (HbA1c) at initiation and top dose of BB. Secondary endpoints included microalbuminuria, changes in lipid profile and estimated glomerular filtration rate (eGFR).Results125 patients were assessed. Both groups were well matched for gender, NYHA class and use of guideline validated heart failure and diabetic medications. The mean treatment duration was 1.9 ± 1.1 years with carvedilol and 1.4 ± 1.0 years with bisoprolol (p = ns). The carvedilol group achieved a reduction in HbA1c (7.8 ± 0.21% to 7.3 ± 0.17%, p = 0.02) whereas the bisoprolol group showed no change in HbA1c (7.0 ± 0.20% to 6.9 ± 0.23%, p = 0.92). There was no significant difference in the change in HbA1c from baseline to peak BB dose in the carvedilol group compared to the bisoprolol group. There was a similar deterioration in eGFR, but no significant changes in lipid profile or microalbuminuria in both groups (p = ns).ConclusionBB use did not worsen glycaemic control, lipid profile or albuminuria status in subjects with SHF and T2DM. Carvedilol significantly improved glycemic control in subjects with SHF and T2DM and this improvement was non significantly better than that obtained with bisoprolol. BB's should not be withheld from patients with T2DM and SHF.
Highlights
The prognostic benefits of beta-blockers (BB) in patients with systolic heart failure (SHF) are known but despite this, in patients with diabetes they are underutilized
We aimed to assess the glycaemic control of patients with Type II diabetes mellitus (T2DM) and SHF treated with BB in a tertiary teaching hospital and the differential effects of a nonselective BB versus a b1 selective BB on glycaemic control, renal function, albuminuria and lipid profile
The mean peak dose of carvedilol was 26.5 ± 21.1 mg/day and bisoprolol was 5.8 ± 3.0 mg/day. Both groups were well matched for gender, New York Heart Association Class (NYHA) class, and use of guideline validated therapies i.e. renin angiotensin system inhibitors, diuretics, spironolactone and diabetes treatment. (Table 1)
Summary
The prognostic benefits of beta-blockers (BB) in patients with systolic heart failure (SHF) are known but despite this, in patients with diabetes they are underutilized. The aim of this study was to assess the effect of beta-blockers (BB) on glycaemic control in patients with Type 2 Diabetes (T2DM) and systolic heart failure (SHF) stratified to beta-1 selective (Bisoprolol) vs nonselective BB (Carvedilol). The prognostic benefits of beta-blockers (BB) in patients with systolic heart failure (SHF) are known [1,2] but despite this, patients with diabetes have been identified as receiving suboptimal treatment with BB [3,4]. We aimed to assess the glycaemic control of patients with T2DM and SHF treated with BB in a tertiary teaching hospital and the differential effects of a nonselective BB (carvedilol) versus a b1 selective BB (bisoprolol) on glycaemic control, renal function, albuminuria and lipid profile
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