title: Intensive Glycemic Therapy in Patients With Type 2 Diabetes on β-Blockers.
abstract: Recent studies have suggested that β-blockers may decrease the adverse influence of hypoglycemia and reduce hypoglycemia-associated cardiac arrhythmias and death. We evaluated whether intensive glycemic therapy in patients with diabetes receiving treatment with β-blockers showed beneficial effects for the prevention of cardiovascular events without increased mortality compared with a standard glycemic therapy.
  
  
  
  We used Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial data to assess the risks of cardiovascular events, all-cause death, and cardiovascular death in patients with diabetes receiving treatment with β-blockers (n = 3,079) and not receiving treatment with β-blockers (n = 7,145) using Cox proportional hazard models.
  
  
  
  In patients receiving treatment with β-blockers, the cumulative event rates for cardiovascular events were significantly lower in the intensive therapy group compared with the standard therapy group (hazard ratio [HR] 0.81; 95% CI 0.67-0.97; P = 0.02), whereas those rates in patients not receiving treatment with β-blockers were not significantly different (HR 0.92; 95% CI 0.78-1.09; P = 0.36). Conversely, the cumulative event rates for all-cause and cardiovascular deaths in patients receiving treatment with β-blockers were not significantly different between the standard therapy and intensive therapy groups (all-cause death: HR 1.08; 95% CI 0.83-1.42; P = 0.54; cardiovascular death: HR 1.05; 95% CI 0.72-1.51; P = 0.79), whereas in patients not receiving treatment with β-blockers, the event rates were significantly higher in the intensive therapy group compared with the standard therapy group (all-cause death: HR 1.25; 95% CI 1.02-1.52; P = 0.02; cardiovascular death: HR 1.43; 95% CI 1.03-1.98; P = 0.03).
  
  
  
  Intensive glycemic therapy may be effective in patients with type 2 diabetes receiving treatment with β-blockers.
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan ttsujimoto@hosp.ncgm.go.jp.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Tsujimoto
authors.affiliation: Department of Clinical Study and Informatics, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan Department of Public Health/Health Policy, The University of Tokyo, Tokyo, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Sugiyama
authors.affiliation: Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan.
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Noda
authors.affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kajio
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D001786:Blood Glucose; D007004:Hypoglycemic Agents