Association between Beta2-Adrenergic Receptor Agonists and the Risk of Vascular Complications in Diabetic Patients: A Population-Based Cohort Study

Beta2-adrenergic receptor (beta 2AR) agonists can have protective effects targeting macrophage activation, but research on human subjects has not been done. This study was designed to assess the relationship between the use of beta 2AR agonists and diabetic vascular complications. Using data from the Korean National Health Insurance Service, adults first diagnosed with diabetes in 2004 (n = 249,222) were followed up until 31 December 2015. Propensity score matching was performed between case and control groups (n = 5179 in each), and multivariate analysis was conducted. The beta 2AR agonist group was divided into quartiles according to the duration of beta 2AR agonist use. During the follow-up, the incidence of vascular complications gradually decreased as the duration of beta 2AR agonist administration increased. Multivariate analysis revealed that the hazard ratio for all composite vascular complications was 0.80 (95% CI, 0.75-0.86, p < 0.001) in the longest quartile of beta 2AR agonist use as compared with the control group after adjusting for confounding variables. The association between the duration of beta 2AR agonist use and the risk of each vascular complication including cerebrovascular, peripheral vascular, peripheral neural, renal, and ophthalmic complications was consistent, and the risks were significantly lower in the longest users than the control group. Long-term use of beta 2AR agonists may exert a protective effect against diabetic vascular complications.