Effect of sacubitril/valsartan versus enalapril on glycaemic control in patients with heart failure and diabetes
The treatment with sacubitril/ valsartan resulted in improved glycaemic control as shown by lower HbA concentrations compared with patients treated with enalapril for patients with diabetes and HFrEF (post-hoc analysis from the PARADIGM-HF trial). This beneficial metabolic effect is most likely secondary to the inhibition of neprilysin and consequent modulation of its circulating substrates. These post-hoc findings should be considered hypothesis-generating and should help inform clinicians who will be using sacubitril/ valsartan in patients with heart failure, especially because doses of insulin or other antihyperglycaemic drugs might need to be adjusted if HbA concentrations decrease. Moreover, these data might encourage additional research into the beneficial metabolic properties of drugs of this class.
Lancet Diabetes Endocrine 2017 May