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Outcomes of “diabetes‐friendly” vs “diabetes‐unfriendly” β‐blockers in older nursing home residents with diabetes after acute myocardial infarction
Author(s) -
Zullo Andrew R.,
Hersey Michelle,
Lee Yoojin,
Sharmin Sadia,
Bosco Elliott,
Daiello Lori A.,
Shah Nishant R.,
Mor Vincent,
Boscardin W. John,
BerardCollins Christine M.,
Dore David D.,
Steinman Michael A.
Publication year - 2018
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13451
Subject(s) - medicine , myocardial infarction , odds ratio , diabetes mellitus , type 2 diabetes , confidence interval , retrospective cohort study , emergency medicine , endocrinology
Aims To assess whether nursing home (NH) residents with type 2 diabetes mellitus (T2D) preferentially received “T2D‐friendly” (vs “T2D‐unfriendly”) β‐blockers after acute myocardial infarction (AMI), and to evaluate the comparative effects of the two groups of β‐blockers. Materials and Methods 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 β‐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 Of 2855 NH residents with T2D, 29% initiated a T2D‐friendly β‐blocker vs 24% of 6098 without T2D ( P < 0.001). For primary outcomes among residents with T2D, T2D‐friendly vs T2D‐unfriendly β‐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 β‐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). Conclusions In older NH residents with T2D, T2D‐friendly β‐blocker use was associated with a lower rate of hospitalization for hyperglycaemia, but a higher rate of all‐cause re‐hospitalization.