Metoprolol and blood sugar levels

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Metoprolol and Blood Sugar Levels: A Comprehensive Review

Introduction to Metoprolol and Blood Sugar Levels

Metoprolol, a cardioselective beta-blocker, is commonly prescribed for managing hypertension and heart conditions. However, its impact on blood sugar levels has been a subject of extensive research, especially in patients with diabetes or those at risk of developing diabetes. This article synthesizes findings from multiple studies to provide a clear understanding of how metoprolol affects blood glucose levels.

Metoprolol and Insulin Sensitivity

Decreased Insulin Sensitivity

Several studies have shown that metoprolol can decrease insulin sensitivity. In a randomized, double-blind study comparing metoprolol and atenolol, both drugs were found to reduce glucose uptake mediated by insulin, indicating decreased insulin sensitivity. This reduction was observed during a euglycemic hyperinsulinemic clamp, a gold-standard method for assessing insulin sensitivity . Additionally, both drugs caused a small increase in fasting plasma insulin and blood glucose concentrations, suggesting a potential risk for developing diabetes in hypertensive patients treated with these medications .

Insulin Response to Glucose Load

In another study, metoprolol did not significantly alter fasting blood glucose or plasma insulin levels, nor did it affect the blood glucose response following an intravenous or oral glucose load. This suggests that while metoprolol may decrease insulin sensitivity, it does not necessarily impair the body's ability to manage glucose under normal conditions .

Metoprolol and Blood Glucose Levels in Diabetic Patients

Impact on Diabetic Control

In hypertensive diabetic patients, metoprolol was found to increase fasting, noon, and mid-afternoon blood sugar concentrations by 1.0-1.5 mmol/l. However, this rise was not significantly greater than that observed with propranolol, a non-selective beta-blocker. The study concluded that while there is a small overall change in diabetic control, it should not deter the use of beta-blockers in non-insulin-dependent diabetics, provided that blood sugar levels are carefully monitored at the onset of treatment .

Long-term Effects

A study focusing on the long-term effects of metoprolol in patients with diastolic hypertension found that while the drug effectively reduced blood pressure, it also caused hyperglycemia. This highlights the importance of monitoring blood glucose levels in patients undergoing long-term treatment with metoprolol .

Comparative Studies with Other Beta-Blockers

Metoprolol vs. Propranolol and Acebutolol

Comparative studies have shown that both metoprolol and propranolol potentiate the initial hypoglycemic action of insulin and delay the return to normoglycemia. However, acebutolol, another cardioselective beta-blocker, did not significantly delay the return to normoglycemia, suggesting it may be a safer option for diabetic patients .

Metoprolol vs. Nebivolol

In a comparative study between nebivolol and metoprolol, nebivolol was found to be more effective in reducing fasting blood glucose levels, postprandial blood glucose levels, and HbA1c levels in patients with type II diabetes mellitus and essential hypertension. Nebivolol also had fewer side effects, making it a potentially better option for managing blood glucose levels in diabetic patients .

Conclusion

Metoprolol, while effective in managing hypertension, has been shown to decrease insulin sensitivity and potentially increase blood glucose levels. These effects necessitate careful monitoring of blood sugar levels, especially in diabetic patients or those at risk of developing diabetes. 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 individual patient's metabolic profile and risk factors.

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·

382citations

·T. Pollare et al.

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·

124citations

·A. Wright et al.

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 Ekberg et al.

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

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

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. Woods et al.

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·

41citations

·N. Clausen-Sjöbom et al.

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·

2citations

·Kamila Fularska et al.

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. Garrett et al.

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 Ah et al.

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