Effect of beta blocker use and type on hypoglycemia risk among hospitalized insulin requiring patients

Cardiovasc Diabetol. 2019 Nov 27;18(1):163. doi: 10.1186/s12933-019-0967-1.


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.

Keywords: Beta blocker; Diabetes mellitus; Hospitalized patients; Hypoglycemia; Mortality.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage
  • Adrenergic beta-Antagonists / adverse effects*
  • Aged
  • Atenolol / administration & dosage
  • Atenolol / adverse effects
  • Biomarkers / blood
  • Blood Glucose / drug effects*
  • Blood Glucose / metabolism
  • Carvedilol / administration & dosage
  • Carvedilol / adverse effects*
  • Female
  • Hospital Mortality
  • Humans
  • Hypoglycemia / blood
  • Hypoglycemia / chemically induced*
  • Hypoglycemia / diagnosis
  • Hypoglycemia / mortality
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / adverse effects*
  • Incidence
  • Inpatients*
  • Insulin / administration & dosage
  • Insulin / adverse effects*
  • Male
  • Metoprolol / administration & dosage
  • Metoprolol / adverse effects
  • Middle Aged
  • Patient Admission*
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors


  • Adrenergic beta-Antagonists
  • Biomarkers
  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin
  • Carvedilol
  • Atenolol
  • Metoprolol