Gazit Sivan, Yonatan Yogev, Hoshen Moshe Baruch, Mahfoud Felix, Patalon Tal Tova
Maccabi Research and Innovation Center, Maccabi Healthcare Services, 27 HaMered St., 68125, Tel Aviv, Israel.
Department of Cardiology, University Heart Center, University Hospital Basel, Basel, Switzerland.
Cardiovasc Drugs Ther. 2025 Jul 28. doi: 10.1007/s10557-025-07753-7.
β-blockers (BB) are a heterogeneous class of medications guideline-recommended for heart failure (HF) and diabetes mellitus (DM). However, physicians may be reluctant to prescribe BBs due to concerns regarding negative metabolic effects. The primary objective was to assess the short-term change in glucose control in PwT2DM (patients with T2DM) who initiated bisoprolol versus the reference cohorts. Secondary objectives were to assess change in lipid control, and proportion of patients with hypoglycemic events during follow-up in PwT2DM who initiated bisoprolol.
We performed a retrospective cohort study of T2DM patients on bisoprolol compared to no treatment, carvedilol, other selective BBs, or nonselective BBs. Anonymized data was collected from the Maccabi Health Services (MHS) database between 2003 and 2023.
A total of 12,981 records were analyzed. The reduction in HbA1C (difference of -0.05 [-0.09, -0.01]), fasting plasma glucose (FPG) (difference of -1.72 [-3.35, -0.1]), and cholesterol measures (total, HDL, LDL differences of -9.12 [-10.94, -7.31], -0.94 [-1.24, -0.65], and -7.89 [-9.53, -6.26], respectively) was significantly greater in the bisoprolol cohort compared to reference cohort 1 (no treatment). In cohort 2, the reduction in HbA1C was significantly greater with carvedilol users compared to bisoprolol users (difference of 0.34 [0.04, 0.63]). The reduction in total cholesterol and LDL was significantly greater in the bisoprolol cohort compared to reference cohort 4 (nonselective BB users, differences of -5.86 [-9.46, -2.25] and -7.08 [-10.25, -3.92], respectively).
Bisoprolol had a neutral effect on the glycemic profile with a statistically beneficial impact on the lipid profile, comparable to carvedilol.
β受体阻滞剂（BB）是一类异质性药物，是心力衰竭（HF）和糖尿病（DM）治疗指南推荐使用的药物。然而，由于担心其负面代谢影响，医生可能不愿开具BB类药物。主要目的是评估起始比索洛尔的2型糖尿病（T2DM）患者与对照队列相比，血糖控制的短期变化。次要目的是评估起始比索洛尔的T2DM患者随访期间血脂控制的变化以及发生低血糖事件的患者比例。
我们进行了一项回顾性队列研究，比较了使用比索洛尔的T2DM患者与未治疗、使用卡维地洛、其他选择性BB或非选择性BB的患者。2003年至2023年期间从马卡比医疗服务（MHS）数据库收集了匿名数据。
共分析了12981条记录。与对照队列1（未治疗）相比，比索洛尔队列中糖化血红蛋白（HbA1C）降低幅度更大（差值为-0.05 [-0.09, -0.01]）、空腹血糖（FPG）降低幅度更大（差值为-1.72 [-3.35, -0.1]）、胆固醇指标（总胆固醇、高密度脂蛋白、低密度脂蛋白差值分别为-9.12 [-10.94, -7.31]、-0.94 [-1.24, -0.65]和-7.89 [-9.53, -6.26]）。在队列2中，使用卡维地洛的患者HbA1C降低幅度比使用比索洛尔的患者更大（差值为0.34 [0.04, 0.63]）。与对照队列4（非选择性BB使用者）相比，比索洛尔队列中总胆固醇和低密度脂蛋白降低幅度更大（差值分别为-5.86 [-9.46, -2.25]和-7.08 [-10.25, -3.92]）。
比索洛尔对血糖状况具有中性作用，对血脂状况具有统计学上的有益影响，与卡维地洛相当。
