Beta-blockers in the type 2 diabetic patients with hypertension – carvedilol yields a favorable metabolic profile

Beta-blockers used in patients with type 2 diabetes, result in greater decrease in cardiac events than in the nondiabetic patient. But at the same time, first-and second-generation beta-blockers are associated with the worsening of insulin resistance, deterioration of glycemic control, peripheral vasoconstriction, and more frequent and severe hypoglycemia. The third-generation beta-blockers have unique properties, including alpha(1)-blockade, and have been shown to lower insulin resistance, improve glycemic control, and vasodilate resistance arterioles. The Glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial has been designed to compare a third-generation (cardevilol) with a second-generation beta-blocker (metoprolol) in a presence of RAS blockade, in a cohort of participants with hypertension and Type 2 diabetes. The outcome measures of the study include change in the HbA(1c) and changes in insulin resistance, fasting glucose, and the lipid profile. The GEMINI trial is the first large randomized trial to assess whether utilizing a third-generation beta-blocker yields a favorable metabolic profile in the patient with Type 2 diabetes and hypertension. Carvedilol, a nonselective beta-blocker with vasodilating and insulin-sensitizing properties, improves some components of the metabolic syndrome and progression to microalbuminuria is observed less frequently.