Differential effect of β-blocker therapy on insulin resistance as a function of insulin sensitizer use: Results from GEMINI

V. Fonseca, G. L. Bakris, D. S H Bell, J. B. McGill, Philip Raskin, F. H. Messerli, R. A. Phillips, R. E. Katholi, J. T. Wright, B. Waterhouse, M. A. Lukas, K. M. Anderson

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Abstract

Aims: To determine whether the beneficial effects of carvedilol on insulin resistance (IR) are affected by the concomitant use of insulin sensitizers [thiazolidinediones (TZDs) and metformin]. Methods: Changes in HbA1c and homeostasis model assessment-insulin resistance (HOMA-IR) were assessed over 5 months, comparing carvedilol with metoprolol tartrate according to insulin sensitizer (TZDs and metformin) use. Results: In TZD/metformin users, carvedilol patients showed a 5.4% decrease [95% confidence interval (CI) -11.9, 1.6; P = 0.13] and metoprolol tartrate patients showed a 2.8% decrease (95% CI -8.5, 3.2; P = 0.35) in HOMA-IR. The -2.6% difference between treatments was not significant (95% CI -10.7, 6.2; P = 0.55). In contrast, those not taking TZD/metformin experienced a 13.2% increase in HOMA-IR on metoprolol tartrate (95% CI 3.2, 24.1; P < 0.01) and a 4.8% decrease in HOMA-IR on carvedilol (95% CI -14.6, 6.0; P = 0.37), with a significant treatment difference of -15.9% favouring carvedilol (95% CI -26.6, -3.6; P = 0.01). There was no significant treatment interaction for the use of TZD/metformin and HbA1c. A statistically significant treatment difference was observed for HbA1c after 5 months favouring carvedilol after adjusting for insulin sensitizer use (-0.11%, 95% CI -0.214, -0.009; P = 0.03). Conclusions: In patients with diabetes and hypertension not taking insulin sensitizers, the use of metoprolol tartrate resulted in a worsening of insulin resistance, an effect not seen with carvedilol. However, in TZD/metformin users the difference between the β-blockers was not statistically significant.

Original languageEnglish (US)
Pages (from-to)759-763
Number of pages5
JournalDiabetic Medicine
Volume24
Issue number7
DOIs
StatePublished - Jul 1 2007

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Keywords

  • Diabetes
  • Hypertension
  • Insulin resistance
  • β-blockers

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Fonseca, V., Bakris, G. L., Bell, D. S. H., McGill, J. B., Raskin, P., Messerli, F. H., Phillips, R. A., Katholi, R. E., Wright, J. T., Waterhouse, B., Lukas, M. A., & Anderson, K. M. (2007). Differential effect of β-blocker therapy on insulin resistance as a function of insulin sensitizer use: Results from GEMINI. Diabetic Medicine, 24(7), 759-763. https://doi.org/10.1111/j.1464-5491.2007.02151.x