Non Users of basal Insulin have high risk of hypoglycemia with Beta-blockers

The use of beta-blockers among hospitalized basal insulin non-users is associated with higher risk for hypoglycemia, which results in increased hospital mortality, regardless of β-blocker use. However, use of β-blocker can reduce early hypoglycemia-associated mortality risk. The study was presented at 78th Scientific Sessions of American Diabetes Association, held from June 22-26, 2018 in Orlando, Florida.

For the study, the researchers analyzed 13,424 participants, 2648 of whom were administered β-blockers at the start of the study. Patients in this study were not in critical condition and had been receiving insulin subcutaneously for 2 years while being monitored for glucose levels. Hypoglycemia, classified as glucose levels below 70 mg/dL, was stratified into hypoglycemia in the first 24 hours of admission (hypo₂₄), through the length of hospitalization (hypo_T), or with glucose less than 40 mg/dL through the length of hospitalization (hypo₄₀).

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Based on the study, the authors found that:

• The likelihood of hypo₂₄, hypo_T, and hypo₄₀ was greater for those who had received β-blockers (Hypo₂₄ fully adjusted odds ratio [OR] 3.79; 95% CI, 3.21-4.50; P<.0001; Hypo_T fully adjusted OR 7.70; 95% CI, 6.77-8.77; P<.0001; Hypo₄₀ OR 1.95; 95% CI 1.49-2.57; P<.0001).


• A higher likelihood of hypo_T and hypo₄₀ was associated with non-use of basal insulin but not with use.


• Hypo₂₄, hypo_T, and hypo₄₀ all correlated with higher rates of mortality after adjustments.


• The use of β-blockers was associated with hypo₂₄ and mortality, but this relationship did not persist at other points.


• Mortality was increased among non-users vs β-blockers users.

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“[β-blocker] use is associated with higher risk of hypoglycemia in hospitalized basal insulin non-users, but not basal insulin users. Hypoglycemia is associated with increased hospital mortality, regardless of [β-blocker] use, but early hypoglycemia-associated mortality risk is attenuated by [β-blocker] use, concluded the authors.