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BACKGROUND: Beta blocker treatment may worsen glucose metabolism. OBJECTIVE: To study the development of new onset diabetes in a large cohort of patients with heart failure treated with either metoprolol or carvedilol. DESIGN: Prospective and retrospective analysis of a controlled clinical trial. SETTING: Multinational multicentre study. PATIENTS: 3029 patients with chronic heart failure. INTERVENTIONS: Randomly assigned treatment with carvedilol (n = 1511, target dose 50 mg daily) or metoprolol tartrate (n = 1518, target dose 100 mg daily). RESULTS: Diabetic events (diabetic coma, peripheral gangrene, diabetic foot, decreased glucose tolerance or hyperglycaemia) and new onset diabetes (clinical diagnosis, repeated high random glucose level or glucose lowering drugs) were assessed in 2298 patients without diabetes at baseline. Diabetic events occurred in 122/1151 (10.6%) patients in the carvedilol group and 149/1147 (13.0%) patients in the metoprolol group (hazard ratio (HR) = 0.78; 95% confidence interval (CI) 0.61 to 0.99; p = 0.039). New onset diabetes was diagnosed in 119/1151 (10.3%) v 145/1147 (12.6%) cases in the carvedilol and metoprolol treatment groups (HR = 0.78, CI 0.61 to 0.997; p = 0.048), respectively. Patients with diabetes at baseline had an increased mortality compared with non-diabetic subjects (45.3% v 33.9%; HR = 1.45, CI 1.28 to 1.65). Both diabetic and non-diabetic subjects at baseline had a similar reduction in mortality with carvedilol compared with metoprolol (RR = 0.85; CI 0.69 to 1.06 and RR = 0.82; CI 0.71 to 0.94, respectively). CONCLUSION: A high prevalence and incidence of diabetes is found in patients with heart failure over a course of 5 years. New onset diabetes is more likely to occur during treatment with metoprolol than during treatment with carvedilol. [ABSTRACT FROM AUTHOR]

An abstract of the study "Exchange of Beta Blocking Therapy in Heart Failure Patients. Experiences From the Post Study Phase of COMET (The Carvedilol or Metoprolol European Trial)," by A. DiLenarda and colleagues is presented.

An abstract of the study "Effect of Long-Term Treatment With Carvedilol Compared to Metoprolol on Heart Failure Morbidity and Diabetes in COMET," by C. Torp-Pedersen and colleagues is presented.

An abstract of the study "Incidence and Type of Adverse Events Occurring With Carvedilol or Metoprolol in the Treatment of Heart Failure; Results From COMET," by P. Poole-Wilson and colleagues is presented.

An abstract of the study "Carvedilol Has a Better Protective Effect Against Major Vascular Events Than Metoprolol in Heart Failure - Results From the COMET Study," by W. Remme and colleagues is presented.

An abstract of the study "Comparison of the Effects of Metoprolol and Carvedilol on Symptoms, Well-Being and Quality-Adjusted Life-Years: A Description of the "Patient-Journey" in COMET, by J. Cleland and colleagues is presented.