Hirst Jennifer A, Farmer Andrew J, Feakins Benjamin G, Aronson Jeffrey K, Stevens Richard J
Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom; National Institute for Health Research School for Primary Care Research, Oxford, United Kingdom.
Br J Clin Pharmacol. 2015 May;79(5):733-43. doi: 10.1111/bcp.12543.
Although there are reports that β-adrenoceptor antagonists (beta-blockers) and diuretics can affect glycaemic control in people with diabetes mellitus, there is no clear information on how blood glucose concentrations may change and by how much. We report results from a systematic review to quantify the effects of these antihypertensive drugs on glycaemic control in adults with established diabetes.
We systematically reviewed the literature to identify randomized controlled trials in which glycaemic control was studied in adults with diabetes taking either beta-blockers or diuretics. We combined data on HbA1c and fasting blood glucose using fixed effects meta-analysis.
From 3864 papers retrieved, we found 10 studies of beta-blockers and 12 studies of diuretics to include in the meta-analysis. One study included both comparisons, totalling 21 included reports. Beta-blockers increased fasting blood glucose concentrations by 0.64 mmol l(-1) (95% CI 0.24, 1.03) and diuretics by 0.77 mmol l(-1) (95% CI 0.14, 1.39) compared with placebo. Effect sizes were largest in trials of non-selective beta-blockers (1.33, 95% CI 0.72, 1.95) and thiazide diuretics (1.69, 95% CI 0.60, 2.69). Beta-blockers increased HbA1c concentrations by 0.75% (95% CI 0.30, 1.20) and diuretics by 0.24% (95% CI -0.17, 0.65) compared with placebo. There was no significant difference in the number of hypoglycaemic events between beta-blockers and placebo in three trials.
Randomized trials suggest that thiazide diuretics and non-selective beta-blockers increase fasting blood glucose and HbA1c concentrations in patients with diabetes by moderate amounts. These data will inform prescribing and monitoring of beta-blockers and diuretics in patients with diabetes.
尽管有报告称β-肾上腺素能受体拮抗剂（β受体阻滞剂）和利尿剂会影响糖尿病患者的血糖控制，但关于血糖浓度如何变化以及变化幅度尚无明确信息。我们报告一项系统评价的结果，以量化这些抗高血压药物对已确诊糖尿病成年人血糖控制的影响。
我们系统地检索文献，以确定在服用β受体阻滞剂或利尿剂的糖尿病成年人中研究血糖控制的随机对照试验。我们使用固定效应荟萃分析合并糖化血红蛋白（HbA1c）和空腹血糖的数据。
从检索到的3864篇论文中，我们发现10项关于β受体阻滞剂的研究和12项关于利尿剂的研究可纳入荟萃分析。一项研究包含了这两种比较，总共21篇纳入报告。与安慰剂相比，β受体阻滞剂使空腹血糖浓度升高0.64 mmol/L（95%可信区间0.24，1.03），利尿剂使空腹血糖浓度升高0.77 mmol/L（95%可信区间0.14，1.39）。在非选择性β受体阻滞剂试验（效应量为1.33，95%可信区间0.72，1.95）和噻嗪类利尿剂试验（效应量为1.69，95%可信区间0.60，2.69）中，效应量最大。与安慰剂相比，β受体阻滞剂使HbA1c浓度升高0.75%（95%可信区间0.30，1.20），利尿剂使HbA1c浓度升高0.24%（95%可信区间 -0.17，0.65）。在三项试验中，β受体阻滞剂与安慰剂之间低血糖事件的数量没有显著差异。
随机试验表明，噻嗪类利尿剂和非选择性β受体阻滞剂会使糖尿病患者的空腹血糖和HbA1c浓度适度升高。这些数据将为糖尿病患者使用β受体阻滞剂和利尿剂的处方及监测提供参考。
