BACKGROUND Although beta blockers could increase the risk of hypoglycemia, the difference between subtypes on hypoglycemia and mortality have not been studied. This study sought to determine the relationship between type of beta blocker and incidence of hypoglycemia and mortality in hospitalized patients. METHODS We retrospectively identified non-critically ill hospitalized insulin requiring patients who were undergoing bedside glucose monitoring and received either carvedilol or a selective beta blocker (metoprolol or atenolol). Patients receiving other beta blockers were excluded. Hypoglycemia was defined as any glucose < 3.9 mmol/L within 24 h of admission (Hypo1day) or throughout hospitalization (HypoT) and any glucose < 2.2 mmol/L throughout hospitalization (Hyposevere). RESULTS There were 1020 patients on carvedilol, 886 on selective beta blockers, and 10,216 on no beta blocker at admission. After controlling for other variables, the odds of Hypo1day, HypoT and Hyposevere were higher for carvedilol and selective beta blocker recipients than non-recipients, but only in basal insulin nonusers. The odds of Hypo1day (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.28, 3.09, p = 0.0002) and HypoT (OR 1.38, 95% CI 1.02, 1.86, p = 0.03) but not Hyposevere (OR 1.90, 95% CI 0.90, 4.02, p = 0.09) were greater for selective beta blocker vs. carvedilol recipients in basal insulin nonusers. Hypo1day, HypoT, and Hyposevere were all associated with increased mortality in adjusted models among non-beta blocker and selective beta blocker recipients, but not among carvedilol recipients. CONCLUSIONS Beta blocker use is associated with increased odds of hypoglycemia among hospitalized patients not requiring basal insulin, and odds are greater for selective beta blockers than for carvedilol. The odds of hypoglycemia-associated mortality are increased with selective beta blocker use or nonusers but not in carvedilol users, warranting further study.

中文翻译：

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β受体阻滞剂的使用和类型对住院胰岛素需求患者低血糖风险的影响。

背景技术尽管β受体阻滞剂可能增加低血糖的风险，但尚未研究低血糖亚型与死亡率之间的差异。这项研究试图确定β受体阻滞剂的类型与住院患者低血糖发生率和死亡率之间的关系。方法我们回顾性鉴定需要住院床边血糖监测并接受卡维地洛或选择性β受体阻滞剂（美托洛尔或阿替洛尔）的非危重住院胰岛素患者。排除接受其他β受体阻滞剂的患者。低血糖症的定义为入院24小时内（Hypo1天）或住院期间（HypoT）的所有葡萄糖<3.9 mmol / L，住院期间（Hyposevere）所有血糖<2.2 mmol / L。结果共有1020例卡维地洛患者，选择性β受体阻滞剂为886，无β受体阻滞剂为10,216。在控制了其他变量之后，卡维地洛和选择性β受体阻滞剂接受者的Hypo1day，HypoT和Hyposevere的几率高于非接受者，但仅在基础胰岛素非使用者中较高。Hypo1day（赔率[OR] 1.99，95％置信区间[CI] 1.28，3.09，p = 0.0002）和HypoT（OR 1.38，95％CI 1.02，1.86，p = 0.03）的赔率，但Hyposevere（OR 1.90）的赔率，非基础胰岛素非使用者中选择性β-受体阻滞剂的95％CI 0.90，4.02，p = 0.09）高于卡维地洛接受者。在非β受体阻滞剂和选择性β受体阻滞剂接受者中，调整模型中的Hypo1day，HypoT和Hyposevere均与死亡率增加相关，但卡维地洛接受者则不然。结论在不需要基础胰岛素的住院患者中，使用β受体阻滞剂与低血糖几率增加有关，选择性β受体阻滞剂的几率大于卡维地洛。选择性β受体阻滞剂的使用或不使用时，与低血糖相关的死亡率增加的可能性增加，但卡维地洛的使用者则没有，因此有待进一步研究。