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Carvedilol, Metoprolol, and Insulin Resistance—Reply
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In Reply: Dr Gonzalez-Feldman raises concerns about interpretation of changes in HOMA-IR. The study by Haffner et al1 was cited to document the validity of HOMA-IR as a measure of insulin resistance in large numbers of patients. HOMA-IR correlates well with more complex testing such as the euglycemic clamp method (r2 = –0.88; P<.001) and the minimal model (r = 0.7; P<.001).2-3 A review of this test in the context of large studies documents its validity.4
Although a change in 2 measurements in the same patient may be due to biological variation, as suggested by Jayagopal et al,5 this is not applicable to large groups, as in the Glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) study.6 This is exemplified by data from the UK Prospective Diabetes Study,7 in which metformin increased insulin sensitivity by 11% in the group that received it; although the group . . . [Full Text of this Article]
David S. Bell, MD
dshbell@uab.edu
University of Alabama School of Medicine
Birmingham
George L. Bakris, MD
Rush University Medical Center
Chicago, Ill
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