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

Kathleen Dungan,Philip Binkley,Clarine Long,Jennifer Merrill

doi:10.1186/s12933-019-0967-1

Kathleen Dungan, Philip Binkley + Show 2 more

Open Access

https://doi.org/10.1186/s12933-019-0967-1

Copy DOI

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.

Highlights

Beta blockers could increase the risk of hypoglycemia, the difference between subtypes on hypoglycemia and mortality have not been studied
Carvedilol and selective beta blocker (SBB) were associated with increased risk of hypoglycemia in patients without heart failure but not in patients with heart failure
This study indicates that Beta blockers (BB) use is associated with increased odds of hypoglycemia in hospitalized insulin requiring patients but this was limited to patients who were not receiving basal insulin

Summary

Introduction

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. Hypoglycemia is even more common among insulin-treated hospitalized patients [2]. Beta blockers (BB) are an essential component of guideline directed therapy for patients with heart failure and coronary artery disease, and are frequently used to treat hypertension. Dungan et al Cardiovasc Diabetol (2019) 18:163 the risk of severe or prolonged hypoglycemia by blunting the early adrenergic symptoms of impending hypoglycemia [8, 9]. Nonselective BB cause concern due to blockade of catecholamine-induced arterial vasodilation mediated by β2 receptors resulting in unopposed α-receptor stimulation during hypoglycemia [10, 11]. In the presence of severe hypoglycemia, BB may decrease the risk of hypoglycemia-associated arrhythmias and death [15, 16]

Objectives

Methods

Results

Discussion

Conclusion