title: Beta blocker use in subjects with type 2 diabetes mellitus and systolic heart failure does not worsen glycaemic control.
abstract: BACKGROUND
  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).
  
  
  METHODS
  This 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).
  
  
  RESULTS
  125 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).
  
  
  CONCLUSIONS
  BB 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.
authors.affiliation: Department of Cardiology, Austin Health, Heidelberg, VIC, Australia.
authors.forename: Bryan
authors.initials: B
authors.lastname: Wai
authors.forename: Leighton G
authors.initials: LG
authors.lastname: Kearney
authors.forename: David L
authors.initials: DL
authors.lastname: Hare
authors.forename: Michelle
authors.initials: M
authors.lastname: Ord
authors.forename: Louise M
authors.initials: LM
authors.lastname: Burrell
authors.forename: Piyush M
authors.initials: PM
authors.lastname: Srivastava
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D017298:Bisoprolol / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006442:Glycated Hemoglobin / Q000378:metabolism; D054143:Heart Failure, Systolic / Q000150:complications / Q000188:drug therapy*; D006784:Hospitals, Teaching; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000627:therapeutic use*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D017298:Bisoprolol; D002227:Carbazoles; D000077261:Carvedilol; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008055:Lipids; D011412:Propanolamines; C517652:hemoglobin A1c protein, human