Journal
DIABETES OBESITY & METABOLISM
Volume 20, Issue 12, Pages 2724-2732Publisher
WILEY
DOI: 10.1111/dom.13451
Keywords
beta-blockers; ageing; diabetes; myocardial infarction; nursing home
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Funding
- Agency for Healthcare Research and Quality award [5K12HS022998]
- Office of Academic Affiliations, Department of Veterans Affairs Advanced Fellowship in Health Services Research and Development
- National Heart, Lung, and Blood Institute [5R01HL111032]
- National Institute on Aging [K24AG049057]
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Aims Materials and Methods 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. 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 Conclusions 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). 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.
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