BackgroundAlthough beta blockers could increase the risk of hypoglycemia, the difference between subtypes on hypoglycemia and mortality have not been studied. This study sought to determine the relationship between type of beta blocker and incidence of hypoglycemia and mortality in hospitalized patients.MethodsWe retrospectively identified non-critically ill hospitalized insulin requiring patients who were undergoing bedside glucose monitoring and received either carvedilol or a selective beta blocker (metoprolol or atenolol). Patients receiving other beta blockers were excluded. Hypoglycemia was defined as any glucose < 3.9 mmol/L within 24 h of admission (Hypo1day) or throughout hospitalization (HypoT) and any glucose < 2.2 mmol/L throughout hospitalization (Hyposevere).ResultsThere were 1020 patients on carvedilol, 886 on selective beta blockers, and 10,216 on no beta blocker at admission. After controlling for other variables, the odds of Hypo1day, HypoT and Hyposevere were higher for carvedilol and selective beta blocker recipients than non-recipients, but only in basal insulin nonusers. The odds of Hypo1day (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.28, 3.09, p = 0.0002) and HypoT (OR 1.38, 95% CI 1.02, 1.86, p = 0.03) but not Hyposevere (OR 1.90, 95% CI 0.90, 4.02, p = 0.09) were greater for selective beta blocker vs. carvedilol recipients in basal insulin nonusers. Hypo1day, HypoT, and Hyposevere were all associated with increased mortality in adjusted models among non-beta blocker and selective beta blocker recipients, but not among carvedilol recipients.ConclusionsBeta blocker use is associated with increased odds of hypoglycemia among hospitalized patients not requiring basal insulin, and odds are greater for selective beta blockers than for carvedilol. The odds of hypoglycemia-associated mortality are increased with selective beta blocker use or nonusers but not in carvedilol users, warranting further study.

Background Most cytologically indeterminate thyroid nodules (ITN) with benign molecular testing do not undergo surgery. The data on clinical outcomes of these nodules are limited. Methods We retrospectively analyzed all ITN that underwent molecular testing with either Afirma Gene Expression Classifier (GEC) or Afirma Gene Sequencing Classifier (GSC) between 2011 and 2018 at a single institution. Results Thirty-eight out of 289 molecularly benign ITN were ultimately resected. The most common reason for surgery was compressive symptoms (39%). In multivariable modeling, patients &lt;40 years old, nodules &gt; 3 cm, presence of Afirma suspicious nodule other than the index nodule and compressive symptoms were associated with higher surgery rates with hazard ratios (HR) for surgery of 3.5 (p&lt;0.001), 3.2 (p&lt;0.001), 16.8 (p&lt;0.001) and 7.31 (p&lt;0.001), respectively. Of resected nodules, 5 were malignant. False-negative rate (FNR) was 1.7% presuming all unresected nodules were truly benign and 13.2% restricting analysis to resected cases. FNR was significantly higher in nodules with a high-risk sonographic appearance for cancer (American Thyroid Association (ATA) high risk classification and American College of Radiology Thyroid Imaging Reporting And Data Systems (ACR-TIRADS) score of 5) compared to nodules with all other sonographic categories (11.8% vs 1.1%, p=0.03 and 11.1% vs. 1.1%, p=0.02, respectively). Conclusions Younger age, larger nodule size, presence of Afirma suspicious nodule other than the index nodule and compressive symptoms were associated with a higher rate of surgery. False-negative rate of benign Afirma was significantly higher in nodules with high-risk sonographic features.

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