Metoprolol and blood sugar

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Metoprolol and Blood Sugar: Impacts on Glucose Metabolism

Introduction to Metoprolol and Blood Sugar Levels

Metoprolol, a cardioselective beta-blocker, is commonly prescribed for managing hypertension and heart conditions. However, its effects on blood sugar levels and glucose metabolism have been a subject of extensive research. This article synthesizes findings from multiple studies to provide a comprehensive understanding of how metoprolol influences blood sugar levels.

Metoprolol and Insulin Sensitivity

Decreased Insulin Sensitivity

Several studies have shown that metoprolol can decrease insulin sensitivity. In a randomized, double-blind study, patients treated with metoprolol exhibited a reduction in glucose uptake mediated by insulin, indicating decreased insulin sensitivity. This was evidenced by a decrease in glucose uptake from 5.6 to 4.5 mg/kg/min during treatment . Another study confirmed that metoprolol treatment led to a small increase in fasting plasma insulin and blood glucose concentrations, suggesting a potential inhibition of insulin release .

Metoprolol and Blood Glucose Levels

Hyperglycemia Risk

Metoprolol has been associated with an increased risk of hyperglycemia. In a study involving patients with diastolic hypertension, those treated with metoprolol showed a significant increase in fasting blood glucose and 2-hour postprandial blood glucose levels after 24 months of treatment . This indicates that while metoprolol is effective in lowering blood pressure, it can also elevate blood glucose levels, necessitating careful monitoring.

Comparative Studies with Other Beta-Blockers

Comparative studies have shown that metoprolol's impact on blood glucose levels is similar to that of non-selective beta-blockers like propranolol. Both drugs were found to increase blood sugar concentrations by 1.0-1.5 mmol/l in hypertensive diabetic patients . However, some studies suggest that metoprolol does not significantly affect glucose tolerance or insulin response in maturity-onset diabetics .

Metoprolol in Diabetic Patients

Effects on Glucose Homeostasis

In hypertensive diabetic patients, metoprolol did not significantly alter glucose homeostasis when combined with hydrochlorothiazide. This combination effectively lowered blood pressure without significantly affecting plasma glucose, insulin, and glucagon levels after an oral glucose load . Another study found that metoprolol did not significantly modify blood glucose levels during prolonged hypoglycemia in insulin-dependent diabetics, although it did elevate plasma insulin levels .

Comparative Efficacy with Nebivolol

A comparative study between nebivolol and metoprolol in type II diabetes mellitus patients with essential hypertension found that nebivolol was more effective in reducing fasting blood glucose levels, postprandial blood glucose levels, and HbA1c levels. Nebivolol also had fewer side effects, making it a preferable option for patients with impaired glucose metabolism .

Conclusion

Metoprolol, while effective in managing hypertension, can impact blood sugar levels and insulin sensitivity. It is associated with a risk of hyperglycemia and decreased insulin sensitivity, necessitating careful monitoring in diabetic patients. Comparative studies suggest that other beta-blockers like nebivolol may offer better glycemic control with fewer side effects. Therefore, the choice of beta-blocker should be tailored to the patient's metabolic profile to ensure optimal management of both cardiovascular and metabolic conditions.

Sources and full results

Most relevant research papers on this topic

Sensitivity to insulin during treatment with atenolol and metoprolol: a randomised, double blind study of effects on carbohydrate and lipoprotein metabolism in hypertensive patients.

Long-term use of metoprolol and atenolol causes metabolic abnormalities, potentially contributing to the increased incidence of diabetes in patients with hypertension treated pharmacologically.

RCTHighly Cited

1989·

380citations

·T. Pollareet al.

British Medical Journal

The effect of Metoprolol on blood glucose in patients with diastolic hypertension

Metoprolol effectively lowers diastolic blood pressure but may cause hyperglycemia, so monitoring blood glucose is crucial.

RCT

2013·

0citations

·Deng Wen-ji

Medical Journal of Chinese People's Health

Metoprolol in diabetes mellitus: effect on glucose homeostasis.

Metoprolol therapy combined with hydrochlorothiazide effectively lowers blood pressure in hypertensive diabetic patients without significantly affecting glucose homeostasis.

Non-RCT

1980·

10citations

·B. Garrettet al.

Clinical science

Beta-adrenoceptor-blocking drugs and blood sugar control in diabetes mellitus.

Beta-blockers can improve blood sugar control in non-insulin-dependent diabetics, with propranolol showing a slightly greater rise in blood sugar than metoprolol.

Highly Cited

1979·

123citations

·A. Wrightet al.

British Medical Journal

Lack of effect of propranolol and metoprolol on glucose tolerance in maturity-onset diabetics.

Propranolol and metoprolol do not significantly affect glucose tolerance or insulin response in maturity-onset diabetics, with no consistent difference between the two drugs.

RCT

1980·

11citations

·K. L. Woodset al.

British Medical Journal

Comparison of propranolol, metoprolol, and acebutolol on insulin-induced hypoglycaemia.

Propranolol and metoprolol both potentiate insulin-induced hypoglycemia and delay return to normal blood glucose levels, while acebutolol also potentiates but does not delay return to normal blood glucose levels.

Non-RCT

1976·

67citations

·R. Newman

British Medical Journal

Glucose tolerance and insulin release in hypertensive patients treated with the cardioselective beta-receptor blocking agent metoprolol.

Metoprolol treatment does not affect blood glucose or insulin levels in hypertensive patients, and does not affect insulin response to i.v. or oral glucose loads.

2009·

46citations

·Göran Ekberget al.

Acta medica Scandinavica

Beta-blockers used in cardiac failure and blood glucose level impairment - a literature review

Metoprolol should not be used in patients with impaired glucose metabolism, while bisoprolol, nebivolol, or carvedilol may be recommended for cardiac failure and impaired carbohydrate metabolism.

Systematic Review

2023·

0citations

·Kamila Fularskaet al.

Journal of Education, Health and Sport

Effects of metoprolol on the counter-regulation and recognition of prolonged hypoglycemia in insulin-dependent diabetics.

Metoprolol does not aggravate prolonged hypoglycemia in insulin-dependent diabetics with blunted glucagon response, and may compensate for its inhibitory effect on insulin clearance through increased responses of counter-regulatory hormones.

Non-RCT

2009·

42citations

·N. Clausen-Sjöbomet al.

Acta medica Scandinavica

To Study the Comparative Effect of Nebivolol and Metoprolol on Fasting and Post meal Blood Glucose Level in Patients of Type II Diabetes Mellitus with Essential Hypertension

Nebivolol is more effective than metoprolol in reducing blood glucose, HbA1c, and blood pressure with lesser side effects in type II diabetic and hypertension patients.

2021·

0citations

·Bhagat Ahet al.

International Journal of Current Research and Review

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