Drugs That Can Worsen Diabetes Control
One of the main goals of any diabetes control regimen is keeping blood glucose levels in the near-normal range. The cornerstones of most plans to achieve that goal include following a healthy diet, getting regular exercise, and taking insulin or other medicines as necessary. However, it’s not uncommon for people with diabetes to have other medical conditions that also require taking medicines, and sometimes these drugs can interfere with efforts to control blood glucose. A few medicines, including some commonly prescribed to treat high blood pressure and heart disease, have even been implicated as the cause of some cases of diabetes. This article lists some of the medicines that can worsen blood glucose control, the reasons they have that effect, the usual magnitude of the blood glucose changes, as well as the pros and cons of using these drugs in people who have diabetes. Where the problems occur To understand how various medicines can worsen blood glucose control, it helps to understand how insulin, the hormone responsible for lowering blood glucose, works in the body. Insulin is released from the beta cells of the pancreas in response to rising levels of glucose in the bloodstream, rising levels of a hormone called GLP-1 (which is released from the intestines in response to glucose), and signals from the nerve connections to the pancreas. The secretion of insulin occurs in two phases: a rapid first phase and a delayed second phase. Both of these phases are dependent on levels of potassium and calcium in the pancreas. Insulin acts on three major organs: the liver, the muscles, and fat tissue. In the liver, insulin enhances the uptake of glucose and prevents the liver from forming new glucose, which it normally does to maintain fasting glucose levels. In muscle and f Continue reading >>
Gemini: Glycemic Effects In Diabetes Mellitus: Carvedilol-metoprolol Comparison In Hypertensives
GEMINI: Glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives Authors: Linda Brookes, MSc Faculty and Disclosures Presenter: George Bakris, MD (Rush Presbyterian/St. Luke's Medical Center, Chicago, Illinois) Although beta blockers are used to treat hypertension in patients with type 2 diabetes mellitus, they appear to increase fasting glucose levels. However, in these high-risk cardiovascular patients, beta-blockers are often used with renin-angiotensin system (RAS)-blocking agents, which are known to improve insulin resistance. Now, a large-scale randomized trial claims to have shown that not all beta-blocker/angiotensin-converting enzyme (ACE) inhibitor combinations are similarly effective in maintaining glycemic control while lowering blood pressure. The results of the Glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial, reported at the American Heart Association (AHA) Scientific Sessions 2004 in New Orleans [1] and published simultaneously in JAMA, [2] showed that although metoprolol or carvedilol given to diabetic patients in combination with a RAS blocker each achieved blood pressure goal, compared with metoprolol, carvedilol was associated with maintenance of glycemic control. Patients on carvedilol also had improved insulin resistance and reduced progression to microalbuminuria. The aim of GEMINI, a randomized, double-blind, parallel-group trial, was to compare the effect of 2 beta-blockers with different pharmacologic profiles: the selective beta1-adrenergic receptor blocker metoprolol (administered as the metoprolol tartrate immediate-release formulation) and the nonselective beta-adrenergic receptor blocker, carvedilol. A total of 125 subjects aged 36-85 years were enrolle Continue reading >>
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New Beta Blocker May Help Diabetic Patients With High Blood Pressure
New beta blocker may help diabetic patients with high blood pressure A medication that is commonly used to control high blood pressure does not raise blood sugar levels in diabetics who also have high blood pressure, according to researchers from Rush University Medical Center . The results of the study appear in the November 10 issue of the Journal of the American Medical Association (JAMA) and were presented today at the 2004 American Heart Association Scientific Sessions. Beta blockers have been shown to be effective at lowering high blood pressure but many physicians have been reluctant to prescribe them to patients with diabetes because some beta-blockers have been shown to raise blood sugar levels in diabetics. Especially at risk are the estimated 47 million people with metabolic syndrome, a combination of several risk factors in one person that includes, but is not limited to, high blood pressure, insulin dependence or glucose intolerance, and obesity. "The results of this study suggest that physicians treating diabetic patients may want to consider the role that a newer beta-blocker such as carvedilol could play in managing certain cardiovascular risk factors and components of the metabolic syndrome ," said Dr. George L. Bakris, director, hypertension research center at Rush University Medical Center. "By improving these crucial risk factors, carvedilol could, theoretically, improve overall outcomes in this high-risk patient population." Bakris was the principal investigator of this 1,235-patient study, which is known as GEMINI (Glycemic Effects in Diabetes Mellitus: Carvedilol - Metoprolol Comparison in Hypertensives). Bakris and colleagues compared the effects of carvedilol to metoprolol tartrate in diabetic, hypertensive patients. Patients were randomized to Continue reading >>
Diabetes Update: Beta Blockers Worsen Blood Sugar--may Cause Diabetes
Beta Blockers Worsen Blood Sugar--May Cause Diabetes Many people know that it is a bad idea for anyone who takes insulin or a sulfonylurea drug to take a beta blocker. This is because it has long been known that these drugs block the counter-regulatory response that prevents a dangerous hypo or--if it cannot prevent the hypo--at least gives the victim some warning that one is coming by causing shakes and pounding pulse. Now evidence from a huge study of almost 20,000 people has learned that beta blockers are dangerous to anyone with any blood sugar abnormality. The study is Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA,). It was published in Diabetes Care in May. Determinants of new-onset diabetes among 19,257 hypertensive patients randomized in the Anglo-Scandinavian Cardiac Outcomes Trial--Blood Pressure Lowering Arm and the relative influence of antihypertensive medication. It concluded: "Baseline FPG >5 mmol/l, BMI, and use of an atenolol +/- diuretic regimen were among the major determinants of NOD [Non-insulin dependent diabetes i.e. Type 2] in hypertensive patients." An analysis of the study (which is still only available as an abstract to non-subscribers) published in Irish Medical News explains "Hypertensive patients allocated to amlodipine and perindopril were found 34% less likely to develop NOD [Type 2] compared with those allocated to the -blocker/diuretic combination." Diabetes in Control adds the following: "Says Dr Anoop Misra, director and head (diabetes and metabolic diseases) Fortis Hospitals: "In patients with hypertension, beta blocker drugs are no longer frontline therapy. These drugs may not only increase blood sugar levels in those who don't have diabetes, but may worsen sugar control in those with diabetes an Continue reading >>
Metoprolol - A Beta-blocker
Metoprolol is used to treat a number of different conditions. If you are unsure why you are taking it, speak with your doctor. Continue to take the tablets regularly unless your doctor tells you to stop. The most common side-effects are feeling tired or dizzy, feeling breathless, headache, and stomach upset. A beta-adrenoceptor blocking medicine (often referred to as a beta-blocker) Hypertension; angina; arrhythmias; to protect the heart; thyroid problems; to prevent migraines Metoprolol belongs to the group of medicines known as beta-blockers . It is a medicine which is used to treat several different medical conditions. It works on the heart and blood vessels. Metoprolol slows down the activity of your heart by stopping messages sent by some nerves to your heart. It does this by blocking tiny areas (called beta-adrenergic receptors) where the messages are received by your heart. As a result, your heart beats more slowly and with less force. This allows the pressure of blood within your blood vessels to be reduced if you have high blood pressure (hypertension) , and helps to prevent abnormally fast heart rhythms (arrhythmias) . Because your heart is using less energy, this helps to reduce chest pain if you have angina . Metoprolol can also help to protect the heart following a heart attack. Metoprolol is also prescribed to help ease some of the symptoms of an overactive thyroid gland , such as a fast heartbeat and trembling. It relieves these symptoms quickly, which allows time for other antithyroid treatments to take effect. Metoprolol is also prescribed to help prevent migraines . It can be helpful for people who find other treatments for migraine unsuitable. Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be use Continue reading >>
Influence Of Beta-blocking Drugs On Glucose Metabolism In Hypertensive, Non-diabetic Patients.
Influence of beta-blocking drugs on glucose metabolism in hypertensive, non-diabetic patients. Groop L , Ttterman KJ , Harno K , Gordin A . Two beta-blocking agents, non-selective propranolol and beta 1-selective metoprolol, were investigated with respect to their effect on glucose metabolism in 11 hypertensive, non-diabetic patients. They were randomly treated for two weeks in a double-blind cross-over manner with propranolol, metoprolol and placebo. Both drugs caused a small but significant increase in basal blood glucose values as compared with placebo (p less than 0.01). Metoprolol increased the blood glucose concentrations during the first 10 min of an i.v. glucose tolerance test (IVGTT) as compared with placebo (p less than 0.02) and propranolol (p less than 0.05). Propranolol raised only the blood glucose values during the later part of the IVGTT (p less than 0.01). The increase in blood glucose concentrations was, however, not associated with significant changes in peripheral insulin levels. The mean basal glucagon concentrations were lower during propranolol and metoprolol than during placebo (p less than 0.01). Propranolol also induced a more pronounced reduction of plasma glucagon than placebo (p less than 0.05) at 10 min of the IVGTT. The mean basal free fatty acid (FFA) concentrations were lower during propranolol (p less than 0.001) and metoprolol (p less than 0.05) than during placebo. Both drugs decreased the plasma levels of FFA during the first 10 min of the IVGTT as compared with placebo (p less than 0.01 and p less than 0.02, respectively). Pharmacological doses of propranolol and metoprolol increased blood glucose concentrations, decreased plasma glucagon and FFA concentrations, but had no effect on serum insulin levels in hypertensive, non-diabeti Continue reading >>
Type 2 Diabetes And Beta-blockers, What You Should Know
Type 2 Diabetes and Beta-Blockers, What You Should Know By Deborah Mitchell G+ Nov 12 2012 - 8:37am When you think about risk factors for type 2 diabetes, obesity, high blood pressure, and inactivity may come to mind. One lesser known factor is use of beta-blockers, but not all of the drugs in this class may raise the chances of developing type 2 diabetes. Some beta-blockers increase diabetes risk Beta-blockers (aka, beta-adrenergic blocking agents or beta antagonists) have been on the market for about six decades. The first clinically beneficial beta-blocker to enter the market was propranolol, which was prescribed to treat angina pectoris, a condition in which the heart's need for oxygen exceeds the available supply. Since then, propranolol and other beta-blockers have been developed and prescribed most often for arrhythmias (abnormal heart rhythms), atrial fibrillation (irregular heart rhythms), high blood pressure, and heart attack, and less often for migraines, anxiety, overactive thyroid, and glaucoma. Beta-blockers work by slowing the heart beat and reducing contractions of blood vessels in the heart, brain, and throughout the body. According to cardiologist Ragaendra R. Baliga at The Ohio State University Wexner Medical Center, "Studies show that older beta- blockers can increase a patient's risk of type 2 diabetes by more than 25 percent." While raising the risk of diabetes is not good for anyone, it is especially damaging for individuals who already have conditions that affect the heart and vascular system. In a recent issue of Heart Failure Clinics, Baliga explained that "older beta-blockers are doubled-edged swords. They save lives, but you want to avoid complications down the road, like diabetes." When some beta-blockers are used for a long time, they may Continue reading >>
What's The Best Beta Blocker For Heart Failure?
Whats the Best Beta Blocker for Heart Failure? Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC. Beta blockers save lives after heart attack and improve mortality for heart failure patients. They also work well to control blood pressure. Carvedilol ( Coreg was the brand name) has beenknown as the heart failure beta blockerbut now it appears that metoprolol ( Lopressor ) may share that title. Many of my patients are asking: which is better? Lets look at the recent evidence. Whats the difference between carvedilol and metoprolol ? Carvedilol is known as a non-selective beta blocker meaning it blocks all beta receptors throughout the body. Metoprolol is known as a selective beta blocker and blocks primarily specific (1) receptors which affect the heart, and heart rate. Why does this matter? Well youd think you only want a medication that affects the heart, but carvedilol alsoinhibits2 receptors and the effects of norepinephrine (similar to adrenaline) throughout the body. Turns out thats important for heart failure. Is carvedilol or metoprolol better for saving lives from heart failure? Well, a JAMA (Journal of the American Medical Association)2014 article looked at mortality rates in heart failure patients and found the effectiveness for prevention of death was similar for carvedilol and metoprolol . However, a very recent VA study found that metoprolol resulted in less frequent hospital admissions for heart failure, and that metoprolol hada slightly lower risk of death than carvedilol . Id say they are about the same, or evidence tips in favor of metoprolol . Which is better for survival after a heart attack? Theyre kind of the same. A recent 2015 stud Continue reading >>
Risk Of Cardiovascular Events In Patients With Diabetes Mellitus On Β-blockers
Although the use of β-blockers may help in achieving maximum effects of intensive glycemic control because of a decrease in the adverse effects after severe hypoglycemia, they pose a potential risk for the occurrence of severe hypoglycemia. This study aimed to evaluate whether the use of β-blockers is effective in patients with diabetes mellitus and whether its use is associated with the occurrence of severe hypoglycemia. Using the ACCORD trial (Action to Control Cardiovascular Risk in Diabetes) data, we performed Cox proportional hazards analyses with a propensity score adjustment. The primary outcome was the first occurrence of a cardiovascular event during the study period, which included nonfatal myocardial infarction, unstable angina, nonfatal stroke, and cardiovascular death. The mean follow-up periods (±SD) were 4.6±1.6 years in patients on β-blockers (n=2527) and 4.7±1.6 years in those not on β-blockers (n=2527). The cardiovascular event rate was significantly higher in patients on β-blockers than in those not on β-blockers (hazard ratio, 1.46; 95% confidence interval, 1.24–1.72; P<0.001). In patients with coronary heart disease or heart failure, the cumulative event rate for cardiovascular events was also significantly higher in those on β-blockers than in those not on β-blockers (hazard ratio, 1.27; 95% confidence interval, 1.02–1.60; P=0.03). The incidence of severe hypoglycemia was significantly higher in patients on β-blockers than in those not on β-blockers (hazard ratio, 1.30; 95% confidence interval, 1.03–1.64; P=0.02). In conclusion, the use of β-blockers in patients with diabetes mellitus was associated with an increased risk for cardiovascular events. Introduction Diabetes mellitus management mainly aims at preventing diabetes mell Continue reading >>
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Antihypertensive Medications And Blood Sugar: Theories And Implications
Go to: MECHANISMS OF ADVERSE GLYCEMIC EFFECTS Various theories about the mechanisms of antihypertensive-induced glycemic defects have been postulated. Few of these theories have been confirmed and some are conflicting. In general, postulated mechanisms can be classified into four categories: effects on peripheral blood flow, effects on the insulin receptor, effects on the liver and effects on insulin release (Figure 1). Improved peripheral blood flow to skeletal muscles is thought to facilitate glucose disposal to the tissues. In this way, medications such as alpha-blockers, which promote peripheral vasodilation, may improve insulin sensitivity and glucose uptake (20). Through the same mechanism, ACEIs or ARBs may improve insulin sensitivity by reducing angiotensin II-mediated vasoconstriction and/or increasing vasodilators such as bradykinin, prostaglandins or nitric oxide (21,22). Conversely, medications that reduce peripheral blood flow could direct blood away from sites of glucose uptake, reducing glucose disposal (20). Nonselective beta-blockers limit peripheral blood flow by reducing cardiac output, a beta-1-mediated effect, and preventing peripheral vasodilation, a beta-2-mediated effect (20,23). Beta-blockers with intrinsic sympathomimetic activity are less likely than nonselective agents to reduce peripheral blood flow because of neutral or stimulatory effects on beta-2 receptors (20,23). Therefore, these agents may have a reduced impact on glucose disposal and insulin sensitivity compared with nonselective beta-blockers. Cardioselective beta-blockers are also less likely to reduce peripheral blood flow than nonselective agents; however, cardioselective beta-blockers still exhibit some glycemic adverse effects (23). In support of the blood flow hypothesis is th Continue reading >>
Beta-blockers 'increase Diabetes Risk By 50 Per Cent'
Beta-blockers 'increase diabetes risk by 50 per cent' Patients taking beta-blockers for their blood pressure have a 50 per cent higher risk of developing diabetes compared to being on newer drugs, researchers have revealed. For the first time, a new study reveals the risk of using the older drugs which are no longer recommended for treating high blood pressure. Patients taking beta-blockers and diuretics - standard medication for over 30 years - are at far greater risk of becoming diabetic. Not only are they less effective than newer medication, but they actually hasten and, in some cases, induce the disease in blood pressure patients - who are already at high risk. This means at least 8,000 Britons taking the older drugs are getting diabetes unnecessarily each year as a result. Until earlier this year, around two million patients have been on beta blocker based treatments at any one time. But new guidance to doctors says newer ace inhibitors and calcium channel blockers should be the first choice treatment for the millions of Britons treated for high blood pressure. The change came after research found the older drugs were only half as effective at stopping strokes and heart attacks. Beta blockers such as atenolol should no longer be prescribed for the problem, said the guidelines from the National Institute for Clinical Excellence. But now a new clinical trial released yesterday show they also bring a 50 per cent higher risk of developing diabetes. Although many patients currently taking them are being switched by their GPs to newer drugs when they go for a scheduled check-up, they remain in wide use. Beta blockers are still considered the best treatment for other conditions such as angina, and doctors have warned patients not to stop taking them without medical advi Continue reading >>
New Onset Diabetes More Likely With Metoprolol Than With Carvedilol In Heart Failure
Home / Resources / Articles / New Onset Diabetes More Likely With Metoprolol Than With Carvedilol in Heart Failure New Onset Diabetes More Likely With Metoprolol Than With Carvedilol in Heart Failure New onset diabetes in patients with chronic heart failure is more likely to develop with metoprolol than with carvedilol, according to new findings Previous studies have shown carvedilol to have a more favorable effect on glucose metabolism than other beta blockers have, the authors explain. Dr. Christian Torp-Pedersen from Bispebjerg University Hospital, Copenhagen, Denmark and colleagues in the Carvedilol or Metoprolol European Trial (COMET) investigated whether carvedilol was associated with a different incidence of new onset diabetes compared with metoprolol in more than 3000 patients with chronic heart failure. Patients taking carvedilol were 22% less likely to develop new onset diabetes than patients taking metoprolol, the authors report. New onset diabetes was diagnosed in 119 out of 1151 (10.3%) of patients taking carvedilol, versus 145 out of 1147 (12.6%) of patients taking metoprolol. Diabetes-related adverse events were also 22% less likely to occur among carvedilol patients: 122 events versus 149 events. Metoprolol remained an independent predictor of new onset diabetes in a multivariable model that included body mass index, hypertension, functional class, and other factors. Patients treated with metoprolol also showed a significant trend for an increase in random blood glucose levels over the course of the trial, the investigators write. Treatment with carvedilol was associated with a nonsignificant risk reduction for mortality compared with metoprolol for diabetic and nondiabetic patients, the researchers note. In a multivariate analysis, however, treatment w Continue reading >>
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Risk Of New-onset Diabetes Mellitus Associated With Beta-blocker Treatment For Hypertension.
Curr Med Res Opin. 2011 Apr;27(4):799-807. doi: 10.1185/03007995.2011.555477. Epub 2011 Feb 10. Risk of new-onset diabetes mellitus associated with beta-blocker treatment for hypertension. Tulane University Health Sciences Center, New Orleans, LA, USA. This study investigated the risk of new-onset diabetes (NOD) among hypertensive patients initiating carvedilol therapy vs other beta-blocker (BB) therapy in a clinical practice setting. Patients aged 18 years with 1 pharmacy claim for a BB of interest (carvedilol immediate-release [IR]/controlled-release [CR], atenolol, metoprolol succinate, or metoprolol tartrate) were identified in the IMS LifeLink Health Plan Claims Database. Index date was the first chronologically occurring prescription for any BB during the enrollment period (July 1, 2000-December 31, 2007). Patients had to be continuously eligible to receive healthcare services 6 months prior to and a minimum of 3 months after index date and have 1 diagnostic code for hypertension (ICD-9-CM: 401.xx-405.xx) during this time frame. Patients were excluded for having a diagnosis of diabetes mellitus (ICD-9-CM: 250.xx) and/or prescription for antidiabetic therapy in the 6 months prior to and/or 3 months after index date. Eligible patients were propensity-score matched in a 1:3 ratio (carvedilol : other BBs). Mean duration of follow-up was 12.8 and 14.8 months for the carvedilol group and other BB group, respectively. Primary outcome of interest was presence and timing of NOD. Among 3084 patients in the carvedilol group and 9252 in the other BB group, mean age was 56 years, with 54% male. NOD rate was 3.16 per 100 person-years for carvedilol patients vs 3.36 for patients in the other BB group (NS). Risk of NOD was similar between groups (HR 0.971, 95% CI: 0.78, 1.21; P Continue reading >>
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Metoprolol Compared To Carvedilol Deteriorates Insulin-stimulated Endothelial Function In Patients With Type 2 Diabetes - A Randomized Study
Metoprolol compared to carvedilol deteriorates insulin-stimulated endothelial function in patients with type 2 diabetes - a randomized study Kveiborg et al; licensee BioMed Central Ltd.2010 Studies of beta blockade in patients with type 2 diabetes have shown inferiority of metoprolol treatment compared to carvedilol on indices of insulin resistance. The aim of this study was to examine the effect of metoprolol versus carvedilol on endothelial function and insulin-stimulated endothelial function in patients with type 2 diabetes. 24 patients with type 2 diabetes were randomized to receive either 200 mg metoprolol succinate or 50 mg carvedilol daily. Endothelium-dependent vasodilation was assessed by using venous occlusion plethysmography with increasing doses of intra-arterial infusions of the agonist serotonin. Insulin-stimulated endothelial function was assessed after co-infusion of insulin for sixty minutes. Vaso-reactivity studies were done before and after the two-month treatment period. Insulin-stimulated endothelial function was deteriorated after treatment with metoprolol, the percentage change in forearm blood-flow was 60.19% 17.89 (at the highest serotonin dosages) before treatment and -33.80% 23.38 after treatment (p = 0.007). Treatment with carvedilol did not change insulin-stimulated endothelial function. Endothelium-dependent vasodilation without insulin was not changed in either of the two treatment groups. This study shows that vascular insulin sensitivity was preserved during treatment with carvedilol while blunted during treatment with metoprolol in patients with type 2 diabetes. MetoprololEndothelial FunctionCarvedilolHealthy Control GroupSodium Nitroprusside Type 2 diabetes is associated with a high risk of cardiovascular complications [ 1 ]. Beta-blo Continue reading >>
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Diabetes And Beta-blockers: What You Need To Know
People with diabetes tend to develop heart disease or stroke at an earlier age than the general population. One reason for this is that high glucose levels increase your risk of high blood pressure (hypertension). According to the American Diabetes Association, almost one in three American adults has high blood pressure. Two out of three people with diabetes have high blood pressure. Type 2 Diabetes and Hypertension High blood pressure doesn’t necessarily cause symptoms. You may feel just fine, but don’t let that fool you. Your heart is working harder than it should. It’s a serious condition, especially for people with diabetes. High blood pressure puts a lot of extra stress on your body. Over time, it can cause hardening of the arteries. It can also damage your brain, kidneys, eyes, and other organs. Treating High Blood Pressure If you have high blood pressure, your doctor may want to try other methods of treating it before turning to beta-blockers. These may include lifestyle changes and taking better control of blood glucose levels. The decision to use medication, including beta-blockers, will depend on your personal medical history. A 2015 study published in the Journal of the American Medical Association recommends drug therapy with a blood pressure reading of above 140 systolic and above 90 diastolic (140/90). For people with diabetes, lowering high blood pressure reduces the risk of developing cardiovascular problems, kidney disease, and neuropathy. Beta-Blockers Beta-blockers (beta-adrenergic blocking agents) are a class of prescription drug. They are used to treat a variety of conditions such as glaucoma, migraines, and anxiety disorders. They are also used to treat heart failure and high blood pressure. High blood pressure can increase your risk for hear Continue reading >>
