Risk of new-onset diabetes mellitus associated with beta-blocker treatment for hypertension

Abstract

Background:

This study investigated the risk of new-onset diabetes (NOD) among hypertensive patients initiating carvedilol therapy vs other beta-blocker (BB) therapy in a clinical practice setting.

Methods:

Patients aged ≥18 years with ≥1 pharmacy claim for a BB of interest (carvedilol immediate-release [IR]/controlled-release [CR], atenolol, metoprolol succinate, or metoprolol tartrate) were identified in the IMS LifeLink Health Plan Claims Database. Index date was the first chronologically occurring prescription for any BB during the enrollment period (July 1, 2000–December 31, 2007). Patients had to be continuously eligible to receive healthcare services 6 months prior to and a minimum of 3 months after index date and have ≥1 diagnostic code for hypertension (ICD-9-CM: 401.xx–405.xx) during this time frame. Patients were excluded for having a diagnosis of diabetes mellitus (ICD-9-CM: 250.xx) and/or prescription for antidiabetic therapy in the 6 months prior to and/or 3 months after index date. Eligible patients were propensity-score matched in a 1:3 ratio (carvedilol : other BBs). Mean duration of follow-up was 12.8 and 14.8 months for the carvedilol group and other BB group, respectively. Primary outcome of interest was presence and timing of NOD.

Results:

Among 3084 patients in the carvedilol group and 9252 in the other BB group, mean age was 56 years, with 54% male. NOD rate was 3.16 per 100 person-years for carvedilol patients vs 3.36 for patients in the other BB group (NS). Risk of NOD was similar between groups (HR 0.971, 95% CI: 0.78, 1.21; P = 0.792).

Conclusions:

Findings suggest the risk of NOD among hypertensive patients is similar between carvedilol and other BB agents (i.e., atenolol, metoprolol succinate, or metoprolol tartrate).

Limitations:

The use of administrative claims data and relatively short follow-up period may limit the generalizability of results.

Key words::

• Beta-blocker
• Carvedilol
• Claims analysis
• Hypertension
• New-onset diabetes
• Observational research

Transparency

Declaration of funding

Funding for the research described in this manuscript, as well as for preparation of the manuscript, was provided by GlaxoSmithKline to Xcenda, LLC. One of the authors, P.P.S., is currently employed by GlaxoSmithKline and contributed to the study concept and design, data analysis and interpretation, drafting of the article, critical revision of the article, and approval of the article.

Declaration of financial/other relationships

P.P.S. is an employee of GlaxoSmithKline. V.F. served as a consultant to GlaxoSmithKline and contributed to the study concept and design, data analysis and interpretation, drafting of the article, critical revision of the article, and approval of the article. M.S. served as a consultant to GlaxoSmithKline and contributed to the study concept and design, data collection, data analysis and interpretation, drafting of the article, critical revision of the article, statistics, and approval of the article. P.D. served as a consultant to GlaxoSmithKline and contributed to the study concept and design, data analysis and interpretation, drafting of the article, critical revision of the article, and approval of the article.

CMRO peer reviewers may receive honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

Kylie Matthews provided editorial assistance in the preparation of this manuscript.