beta-blocker use and diabetes symptom score: results from the GEMINI study.
OBJECTIVE
The Glycemic Effect in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial compared the metabolic effects of two beta-blockers in people with type 2 diabetes and hypertension treated with renin-angiotensin system (RAS) blockade and found differences in metabolic outcomes. In this paper, we report the results of a prespecified secondary analysis of GEMINI that sought to determine the effect of these two beta-blockers on commonly reported symptoms.


METHODS
The Diabetes Symptom Checklist (DSC), a self-report questionnaire measuring the occurrence and perceived burden of diabetes-related symptoms, was completed by GEMINI participants at baseline and at the end of the study (maintenance month 5). The DSC assessed symptoms in eight domains: psychology (fatigue), psychology (cognitive), neuropathy (pain), neuropathy (sensory), cardiology, ophthalmology, hyperglycaemia and hypoglycaemia.


RESULTS
Comparison of the mean change in self-reported diabetes-related symptoms indicated a significant treatment difference favouring carvedilol over metoprolol tartrate in overall symptom score (-0.08; 95% CI -0.15, -0.01; p = 0.02) and in the domains for hypoglycaemia symptoms (-0.12; 95% CI -0.23, -0.02; p = 0.02) and hyperglycaemia symptoms (-0.16; 95% CI -0.27, -0.05; p = 0.005). Carvedilol resulted in fewer perceived diabetes-related symptoms in patients with diabetes and hypertension.


CONCLUSIONS
Carvedilol resulted in a lower perceived burden of diabetes-related symptoms in patients with type 2 diabetes and hypertension. The addition of a well-tolerated beta-blocker to RAS blockade may improve hypertension treatment and quality of life in patients with diabetes.
McGill
J B
JB
Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA. jmcgill@im.wustl.edu
Bakris
G L
GL
Fonseca
V
V
Raskin
P
P
Messerli
F H
FH
Phillips
R A
RA
Katholi
R E
RE
Wright
J T
JT
Iyengar
M
M
Anderson
K M
KM
Lukas
M A
MA
Dalal
M R
MR
Bell
D S H
DS
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D003071:Cognition / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D004311:Double-Blind Method; D005221:Fatigue / Q000523:psychology; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D007003:Hypoglycemia / Q000503:physiopathology; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D009422:Nervous System Diseases / Q000503:physiopathology; D010146:Pain / Q000503:physiopathology; D011412:Propanolamines / Q000627:therapeutic use*; D012084:Renin-Angiotensin System / Q000187:drug effects; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol