Volume 2 Issue 7
July 2017  
Context and Study Objective
The adverse metabolic effects of diuretics were chronicled in a previous issues. However, physicians often overlook similar side effects when prescribing beta-blockers. This article analyzes the association between metoprolol or carvedilol therapy and weight gain among type 2 diabetics.

Design, Setting, and Participants
-Body weight upon study initiation and termination from the randomized double-blind GEMINI trial were compared. After randomization, carvedilol and metoprolol tartrate were uptitrated to achieve a goal BP of 135/85 mm Hg. Final body weight determinations were made after 5 months on stable doses of each agent. Only those on stable diabetic and anti-hypertensive regimens were eligible.  
-GlaxoSmithKline, the patent holder of carvedilol (Coreg), sponsored the study.
-1200 patients were randomized with 90% completing the study. The mean age was 61 with 55% being men. Mean  HbA1c was 7.2%. BMI was 34 kg/m2.  The number of additional anti-hypertensives and diabetic agents required during the course of the study were similar between groups.
-BP fell from 149/86 on entry to 132/77 mm Hg upon study completion. The average carvedilol dose required was 17.5mg BID; average metoprolol tartrate dose was 125 mg BID.
-After 5 months of therapy, body weight rose 1.2 kg among those prescribed metoprolol but only 0.2 kg among those receiving carvedilol. 
-Table: Those with the highest BMIs upon study initiation experienced the most weight gain. 
Clinical Perspective

-Given hypertensives often suffer from the metabolic syndrome, weight gains of 1-2 kg are meaningful and can worsen insulin resistance and other comorbids.   
-Disclosures: The study was funded by the patent holder of carvedilol (Coreg). I have no conflicts of interest. 
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