• Type 2 diabetes and chronic heart failure – which beta blockers do not affect glycemic control?

    December 16, 2014

    There are beta-blockers (BB), which do not affect the glycemic metabolism in patients with type 2 diabetes (DT2) complicated with heart failure (HF) and carvedilol even improves the regulation of glucose – showed the results of an observational study published in the journal Cardiovascular Diabetology.

    The prognostic significance of BB in patients with systolic heart failure has long been known, but in diabetics the treatment with BB is suboptimal (drugs are not included or the dose is not optimal).

    This fact may have important clinical implications for patients, since in some 12% of the patients with DT2 is observed systolic heart failure, and in the group with HF – 6 to 25% are diabetics. Therefore, for the proper treatment of this population it is particularly important to use BB which allow to maintain good glycemic control.

    Earlier, in the study GEMINI (GEMINI – The Glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives), in hypertensive patients with DT2 who did not have systolic heart failure, the administration of carvedilol was associated with beneficial effects on the metabolism of glucose (most probably, due to the increased uptake of glucose) compared to metoprolol tartrate.

    The treatment with carvedilol did not affect the glycemic control (did not lead to a change in the baseline of glycosylated hemoglobin A1c) while achieving an improvement in insulin sensitivity and a decrease the progression of microalbuminuria compared with metoprolol tartrate, concluded the authors of GEMINI.

    The aim of this study was to evaluate the effect of two different BB: the non-selective BB carvedilol and the beta 1 selective BB bisoprolol on glycemic control, the lipid profile, the renal function and microalbuminuria in patients with HF and DT2.

    125 people took part in it, without BB therapy before enrollment. 80 of them started treatment with carvedilol, and the remaining 45 – with bisoprolol, with gradual titration to the maximum tolerated dose, which was 26.5 ± 21.1 mg daily for carvedilol and 5.8 ± 3.0 mg daily for bisoprolol.

    The rest of the therapy was carried out according to the recommendations for the treatment of HF. The average follow-up period in the carvedilol group was 1.9 years, and in the bisoprolol group – 1.4 years. The two treatment groups did not differ considerably in terms of demographic characteristics, ejection fraction of the left ventricle, functional class of heart failure and concomitant therapy.

    Patients treated with carvedilol had significant reductions in glycosylated hemoglobin levels (HbA1c) – from 7.8 to 7.3, compared to the ones on therapy with bisoprolol where the values of HbA1c were not significantly lower – from 7.0 to 6.9.

    The glomerular filtration rate (GFR) showed a decrease in the course of study, without significantly differing depending on the applied BB. The percentage of patients with microalbuminuria remained stable during follow-up. No significant changes in lipid profile were observed.

    This study, with a sufficiently long follow-up period, was able to prove that carvedilol did not worsen glycemic control and the lipid profile – its administration even lead to significant reduction in the baseline HbA1c

    Tchaikapharma – High Quality Medicines Inc. produces licensed Dilatrend (carvedilol) and is a Marketing Authorization Holder of the product.

    Dilatrend has been in the list of NHIF since the 16th of November 2014, with the following codes:
    Dilatrend 6.25 mg x 28 tabl. – CG 221
    Dilatrend 12.5 mg x 28 tabl. – CG 220
    Dilatrend 25 mg x 28 tabl. – CG 219