Are β-Blockers Problematic in Intensively Treated Type 2 Diabetic Patients?

In the ACCORD trial, which involved patients (mean age, 63) with longstanding type 2 diabetes and high risk for adverse cardiovascular (CV) events, intensive glycemic control was compared with standard glycemic control. Intensive control resulted in a slight excess of overall and CV-related mortality, a small reduction in nonfatal myocardial infarction, and a higher rate of severe hypoglycemia (NEJM JW Gen Med Jul 1 2008 and N Engl J Med 2008; 358:2545). In this post hoc analysis of ACCORD data, researchers examined whether background treatment with β-blockers was associated with better or worse outcomes. If the excess mortality with intensive treatment was mediated in part by hypoglycemia, β-blockers could be either beneficial or harmful: …