Outcomes of "diabetes-friendly" vs "diabetes-unfriendly" beta-blockers in older nursing home residents with diabetes after acute myocardial infarction

TitleOutcomes of "diabetes-friendly" vs "diabetes-unfriendly" beta-blockers in older nursing home residents with diabetes after acute myocardial infarction
Publication TypeJournal Article
Year of Publication2018
AuthorsZullo A.R, Hersey M., Lee Y., Sharmin S., Bosco E., Daiello L.A, Shah N.R, Mor V., Boscardin W.J, Berard-Collins C.M, Dore D.D, Steinman M.A
JournalDiabetes Obes Metab
Date PublishedDec
ISBN Number1462-8902
Accession Number29952104
Keywords*ageing, *beta-blockers, *diabetes, *myocardial infarction, *nursing home, Adrenergic beta-Antagonists/*pharmacology, Aged, 80 and over, Blood Glucose/*drug effects, Carvedilol/pharmacology, Diabetes Mellitus, Type 2/blood/complications/*drug therapy, Female, Hospitalization/*statistics & numerical data, Humans, Hyperglycemia/chemically induced, Hypoglycemia/chemically induced, Labetalol/pharmacology, Logistic Models, Male, Medicare, Myocardial Infarction/blood/complications/*drug therapy, Nebivolol/pharmacology, Nursing Homes, Odds Ratio, Retrospective Studies, Treatment Outcome, United States

AIMS: To assess whether nursing home (NH) residents with type 2 diabetes mellitus (T2D) preferentially received "T2D-friendly" (vs "T2D-unfriendly") beta-blockers after acute myocardial infarction (AMI), and to evaluate the comparative effects of the two groups of beta-blockers. MATERIALS AND METHODS: This new-user retrospective cohort study of NH residents with AMI from May 2007 to March 2010 used national data from the Minimum Data Set and Medicare system. T2D-friendly beta-blockers were those hypothesized to increase peripheral glucose uptake through vasodilation: carvedilol, nebivolol and labetalol. Primary outcomes were hospitalizations for hypoglycaemia and hyperglycaemia in the 90 days after AMI. Secondary outcomes were functional decline, death, all-cause re-hospitalization and fracture hospitalization. We compared outcomes using binomial and multinomial logistic regression models after propensity score matching. RESULTS: Of 2855 NH residents with T2D, 29% initiated a T2D-friendly beta-blocker vs 24% of 6098 without T2D (P < 0.001). For primary outcomes among residents with T2D, T2D-friendly vs T2D-unfriendly beta-blockers were associated with a reduction in hospitalized hyperglycaemia (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.21-0.97), but unassociated with hypoglycaemia (OR 2.05, 95% CI 0.82-5.10). For secondary outcomes, T2D-friendly beta-blockers were associated with a greater rate of re-hospitalization (OR 1.26, 95% CI 1.01-1.57), but not death (OR 1.06, 95% CI 0.85-1.32), functional decline (OR 0.91, 95% CI 0.70-1.19), or fracture (OR 1.69, 95% CI 0.40-7.08). CONCLUSIONS: In older NH residents with T2D, T2D-friendly beta-blocker use was associated with a lower rate of hospitalization for hyperglycaemia, but a higher rate of all-cause re-hospitalization.





Short TitleDiabetes, obesity & metabolismDiabetes, obesity & metabolism
Alternate JournalDiabetes, obesity & metabolism