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Patients with chronic heart failure are more likely to develop diabetes if treated with metoprolol than carvedilol. A double blind trial (COMET) recruited 3029 patients with heart failure and left ventricular systolic dysfunction to receive one or the other β blocker as well as their standard treatment. Of the 2298 not diabetic at trial entry, diabetes developed in 264 (11.5%) during 47-72 months of follow up. As expected, this was more likely in those with a high body mass index, history of hypertension, and more severe heart failure. However, it was less likely in those treated with carvedilol than metoprolol (119/1151 (10.1%) and 145/1147 (12.6%) respectively, hazard ratio 0.78 (95% CI 0.61 to 0.99)). Of those patients not diabetic at study onset and taking metoprolol, 38.1% (95% CI 35.1% to 41.2%) died during follow-up, compared with 32.7% (29.8% to 35.7%) of those taking carvedilol.