Chintan V Dave1,2,3, Brian L Strom1,4, Fred A Kobylarz5, Daniel B Horton1,6,7, Tobias Gerhard1,2,7, Chin-Lin Tseng3, Ilja Dejanovic8, Abner Nyandege1, Soko Setoguchi1,7,8. 1. Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA. 2. Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA. 3. Department of Veterans Affairs-New Jersey Health Care System, East Orange, New Jersey, USA. 4. Rutgers Biomedical and Health Sciences, Stratford, New Jersey, USA. 5. Department of Family Medicine and Community Health, Geriatrics Program, Robert Wood Johnson Medical School, Rutgers University Biomedical and Health Sciences, New Brunswick, New Jersey, USA. 6. Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA. 7. Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA. 8. Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Abstract
BACKGROUND: Although prior literature suggests that metoprolol may worsen glucose control compared to carvedilol, whether this has clinical relevance among older adults with diabetes and heart failure (HF) remains an open question. METHODS: This was a US retrospective cohort study utilizing data sourced from a 50% national sample of Medicare fee-for-service claims of patients with part D prescription drug coverage (2007-2017). Among patients with diabetes and HF, we identified initiators of metoprolol or carvedilol, which were 1:1 propensity score matched on >90 variables. The primary outcome was initiation of a new oral or injectable antidiabetic medication (proxy for uncontrolled diabetes); secondary outcomes included initiation of insulin and severe hyperglycemic event (composite of emergency room visits or hospitalizations related to hyperglycemia). RESULTS: Among 24 239 propensity score-matched pairs (mean [SD] age 77.7 [8.0] years; male [39.1%]), there were 8150 (incidence rate per 100 person-years [IR] = 33.5) episodes of antidiabetic medication initiation among metoprolol users (exposure arm) compared to 8576 (IR = 33.4) among carvedilol users (comparator arm) compared to corresponding to an adjusted hazard ratio (aHR) of 0.97 (95% confidence interval [CI]: 0.94, 1.01). Similarly, metoprolol was not associated with a significant increase in the risk of secondary outcomes including insulin initiation: aHR of 0.98 (95% CI: 0.93, 1.04) and severe hyperglycemic events: aHR of 0.98 (95% CI: 0.93, 1.02). CONCLUSIONS: In this large study of older adults with HF and diabetes, initiation of metoprolol compared to carvedilol was not associated with an increase in the risk of clinically relevant hyperglycemia.
BACKGROUND: Although prior literature suggests that metoprolol may worsen glucose control compared to carvedilol, whether this has clinical relevance among older adults with diabetes and heart failure (HF) remains an open question. METHODS: This was a US retrospective cohort study utilizing data sourced from a 50% national sample of Medicare fee-for-service claims of patients with part D prescription drug coverage (2007-2017). Among patients with diabetes and HF, we identified initiators of metoprolol or carvedilol, which were 1:1 propensity score matched on >90 variables. The primary outcome was initiation of a new oral or injectable antidiabetic medication (proxy for uncontrolled diabetes); secondary outcomes included initiation of insulin and severe hyperglycemic event (composite of emergency room visits or hospitalizations related to hyperglycemia). RESULTS: Among 24 239 propensity score-matched pairs (mean [SD] age 77.7 [8.0] years; male [39.1%]), there were 8150 (incidence rate per 100 person-years [IR] = 33.5) episodes of antidiabetic medication initiation among metoprolol users (exposure arm) compared to 8576 (IR = 33.4) among carvedilol users (comparator arm) compared to corresponding to an adjusted hazard ratio (aHR) of 0.97 (95% confidence interval [CI]: 0.94, 1.01). Similarly, metoprolol was not associated with a significant increase in the risk of secondary outcomes including insulin initiation: aHR of 0.98 (95% CI: 0.93, 1.04) and severe hyperglycemic events: aHR of 0.98 (95% CI: 0.93, 1.02). CONCLUSIONS: In this large study of older adults with HF and diabetes, initiation of metoprolol compared to carvedilol was not associated with an increase in the risk of clinically relevant hyperglycemia.
Authors: Jeremy Walston; Evan C Hadley; Luigi Ferrucci; Jack M Guralnik; Anne B Newman; Stephanie A Studenski; William B Ershler; Tamara Harris; Linda P Fried Journal: J Am Geriatr Soc Date: 2006-06 Impact factor: 5.562
Authors: Ian H de Boer; Sripal Bangalore; Athanase Benetos; Andrew M Davis; Erin D Michos; Paul Muntner; Peter Rossing; Sophia Zoungas; George Bakris Journal: Diabetes Care Date: 2017-09 Impact factor: 19.112
Authors: Britt Kveiborg; Thomas S Hermann; Atheline Major-Pedersen; Buris Christiansen; Christian Rask-Madsen; Jakob Raunsø; Lars Køber; Christian Torp-Pedersen; Helena Dominguez Journal: Cardiovasc Diabetol Date: 2010-05-25 Impact factor: 9.951
Authors: Shannon M Dunlay; Margaret M Redfield; Susan A Weston; Terry M Therneau; Kirsten Hall Long; Nilay D Shah; Véronique L Roger Journal: J Am Coll Cardiol Date: 2009-10-27 Impact factor: 24.094
Authors: Franz H Messerli; David S H Bell; Vivian Fonseca; Richard E Katholi; Janet B McGill; Robert A Phillips; Philip Raskin; Jackson T Wright; Sripal Bangalore; Fred K Holdbrook; Mary Ann Lukas; Karen M Anderson; George L Bakris Journal: Am J Med Date: 2007-07 Impact factor: 4.965
Authors: Scott Martin Vouri; Xinyi Jiang; Todd M Manini; Laurence M Solberg; Carl Pepine; Daniel C Malone; Almut G Winterstein Journal: JAMA Netw Open Date: 2019-12-02
Authors: Qonita Kurnia Anjani; Akmal Hidayat Bin Sabri; Mary B McGuckin; Huanhuan Li; Khuriah Abdul Hamid; Ryan F Donnelly Journal: AAPS PharmSciTech Date: 2022-10-04 Impact factor: 4.026