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March 9, 2005

Carvedilol, Metoprolol, and Insulin Resistance

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(10):1190. doi:10.1001/jama.293.10.1190-a

To the Editor: The study by Dr Bakris and colleagues1 comparing the metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension found that insulin sensitivity improved with carvedilol (–9.1%; P = .004) but not metoprolol (–2.0%; P = .48), with a between-group difference of –7.2% (95% confidence interval [CI], –13.8% to –0.2%). The reference the article cites supporting the use of the Homeostasis Model Assessment–Insulin Resistance (HOMA-IR) as the tool to measure insulin resistance was the study by Haffner et al.2 This was a prospective study assessing predictors of development of diabetes mellitus in 3.5 years of follow-up. Jayagopal et al3 studied the variation of HOMA indices and showed that to consider a change of HOMA as clinically significant, the new value must represent at least a 90% increase or a 47% decrease. The mean improvement in HOMA-IR of 9% in the present study may be statistically significant but not clinically significant.

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