Effects of metoprolol and carvedilol on pre-existing and new onset diabetes in patients with chronic heart failure: data from the Carvedilol Or Metoprolol European Trial (COMET)
Open accessAbstract
Background: β Blocker treatment may worsen glucose metabolism. Objective: To study the development of new onset diabetes in a large cohort of patients with heart failure treated with either metoprolol or carvedilol. Design: Prospective and retrospective analysis of a controlled clinical trial. Setting: Multinational multicentre study. Patients: 3029 patients with chronic heart failure. Interventions: Randomly assigned treatment with carvedilol (n = 1511, target dose 50 mg daily) or metoprolol tartrate (n = 1518, target dose 100 mg daily). Results: Diabetic events (diabetic coma, peripheral gangrene, diabetic foot, decreased glucose tolerance or hyperglycaemia) and new onset diabetes (clinical diagnosis, repeated high random glucose level or glucose lowering drugs) were assessed in 2298 patients without diabetes at baseline. Diabetic events occurred in 122/1151 (10.6%) patients in the carvedilol group and 149/1147 (13.0%) patients in the metoprolol group (hazard ratio (HR) = 0.78; 95% confidence interval (CI) 0.61 to 0.99; p = 0.039). New onset diabetes was diagnosed in 119/1151 (10.3%) v 145/1147 (12.6%) cases in the carvedilol and metoprolol treatment groups (HR = 0.78, CI 0.61 to 0.997; p = 0.048), respectively. Patients with diabetes at baseline had an increased mortality compared with non-diabetic subjects (45.3% v 33.9%; HR = 1.45, CI 1.28 to 1.65). Both diabetic and non-diabetic subjects at baseline had a similar reduction in mortality with carvedilol compared with metoprolol (RR = 0.85; CI 0.69 to 1.06 and RR = 0.82; CI 0.71 to 0.94, respectively). Conclusion: A high prevalence and incidence of diabetes is found in patients with heart failure over a course of 5 years. New onset diabetes is more likely to occur during treatment with metoprolol than during treatment with carvedilol.
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In head-to-head trials, patients with type 2 diabetes treated with vasodilating versus nonvasodilating β-blockers had small but significant decreases in HbA1c levels (0.1%-0.2%), improved insulin sensitivity, lower cholesterol levels, less weight gain, and less progression to microalbuminuria.
“In head-to-head trials, patients with T2DM who were treated with vasodilating (versus nonvasodilating) β-blockers had small but significant decreases in HbA1c levels (0.1%–0.2%), improved insulin sensitivity, lower cholesterol levels, less weight gain, and less progression to microalbuminuria.”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [256]
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- Authors
- Torp-Pedersen, C., Metra, M., Charlesworth, A., Spark, P., Lukas, M. A., Poole-Wilson, P. A., Swedberg, K., Cleland, J. G. F., Di Lenarda, A., Remme, W. J., & Scherhag, A.
- Affiliations
- Bispebjerg Hospital (DK)
- University of Brescia (IT)
- Nottingham Clinical Research Group (NCRG), Nottingham, UK
- GlaxoSmithKline (United States) (US)
- Imperial College London (GB)
- Sahlgrenska University Hospital (SE)
- University of Hull (GB)
- Department of Cardiology, Ospedale di Cattinara, Trieste, Italy
- Sticares Cardiovascular Research Foundation, Rhoon, Netherlands
- F. Hoffmann-La Roche AG (CH)
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2007-01-19
- Volume
- 93
- Issue
- 8
- Pages
- 968-973
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- PMC
- PMC1994413
- OpenAlex
- W2139561039
- Cited by
- 171
- References
- 6
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 6 · 2020: 10 · 2019: 10 · 2018: 3 · 2017: 7 · 2016: 6 · 2015: 9 · 2014: 9 · 2013: 7 · 2012: 13
- FWCI
- 11.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Heart (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Funders
- GlaxoSmithKline
- F. Hoffmann-La Roche
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Keywords
- carvedilol, metoprolol, chronic heart failure, new-onset diabetes, pregestational diabetes, beta-blockers, glucose metabolism, diabetes complications, mortality, glucose tolerance, hyperglycemia, diabetic foot, diabetic coma, peripheral gangrene, antidiabetic drugs
- MeSH terms
- Carvedilol, Adrenergic beta-Antagonists, Aged, Blood Glucose, Carbazoles, Diabetes Mellitus, Double-Blind Method, Europe, Female, Heart Failure, Humans, Male, Metoprolol, Middle Aged, Propanolamines, Prospective Studies, Retrospective Studies, Incidence, Prevalence, Chi-Square Distribution
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