title: Type of β-blocker use among patients with versus without diabetes after myocardial infarction.
abstract: BACKGROUND
  Discharge β-blocker prescription after myocardial infarction (MI) is recommended for all eligible patients. Numerous β-blocker choices are presently available with variable glycometabolic effects, which could be an important consideration in patients with diabetes mellitus (DM). Whether patients with DM preferentially receive β-blockers with favorable metabolic effects after MI and if this choice is associated with better glycemic control postdischarge is unknown.
  
  
  METHODS
  Among patients from 24 US hospitals enrolled in an MI registry (2005-2008), we investigated the frequency of "DM-friendly" β-blocker prescription at discharge by DM status. β-Blockers were classified as DM-friendly (eg, carvedilol and labetalol) or non-DM-friendly (eg, metoprolol and atenolol), based on their effects on glycemic control. Hierarchical, multivariable logistic regression examined the association of DM with DM-friendly β-blocker use. Among DM patients, we examined the association of DM-friendly β-blockers with worsened glycemic control at 6 months after MI.
  
  
  RESULTS
  Of 4,031 MI patients, 1,382 (34%) had DM. β-Blockers were prescribed at discharge in 93% of patients. Diabetes mellitus-friendly β-blocker use was low regardless of DM status, although patients with DM were more likely to be discharged on a DM-friendly β-blocker compared with patients without DM (13.5% vs 10.3%, P = .003), an association that remained after multivariable adjustment (odds ratio 1.41, 95% CI 1.13-1.77). There was a trend toward a lower risk of worsened glucose control at 6 months in DM patients prescribed DM-friendly versus non-DM-friendly β-blockers (Relative Risk 0.80, 95% CI 0.60-1.08).
  
  
  CONCLUSIONS
  Most DM patients were prescribed non-DM-friendly β-blockers-a practice that was associated with a trend toward worse glycemic control postdischarge. Although in need of further confirmation in larger studies, our findings highlight an opportunity to improve current practices of β-blockers use in patients with DM.
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO. Electronic address: suz.v.arnold@gmail.com.
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Yale School of Medicine, New Haven, CT.
authors.forename: Kasia J
authors.initials: KJ
authors.lastname: Lipska
authors.affiliation: Henry Ford Hospital, Detroit, MI.
authors.forename: David E
authors.initials: DE
authors.lastname: Lanfear
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO.
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
authors.forename: Anna
authors.initials: A
authors.lastname: Grodzinsky
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.affiliation: University of Colorado School of Medicine, Denver, CO.
authors.forename: M Odette
authors.initials: MO
authors.lastname: Gore
authors.affiliation: Emory School of Medicine, Atlanta, GA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Goyal
authors.affiliation: University of Colorado School of Medicine, Denver, CO; VA Eastern Colorado Health Care System, Denver, CO.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kosiborod
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D000075202:Contraindications; D003925:Diabetic Angiopathies / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D011412:Propanolamines / Q000627:therapeutic use; D012042:Registries
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol