Intensive Glycemic Therapy in Patients With Type 2 Diabetes on β-Blockers

Abstract

OBJECTIVE 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. RESEARCH DESIGN AND METHODS 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. RESULTS 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). CONCLUSIONS Intensive glycemic therapy may be effective in patients with type 2 diabetes receiving treatment with β-blockers.