By Pam Brown, Editor-in-Chief, Diabetes & Primary Care
The PARADIGM-HF trial (n=8399) compared sacubitril/valsartan with enalapril in patients with heart failure with reduced ejection fraction (HFrEF). Post hoc analysis of data by Seferovic et al (2017) from the 3778 patients with known diabetes or HbA1c ≥48 mmol/mol (6.5%) at baseline showed small, persisting improvements in glycaemic control over the 3-year study, as well as 29% reduction in insulin initiation and reduced oral hypoglycaemic drug initiation in those treated with sacubitril/valsartan compared to those treated with enalapril. HbA1c reductions were small and there was no reduction in the pre-specified outcome of new-onset diabetes. However, the authors propose the glucose-lowering effect may be large enough to necessitate reducing the dose of antihyperglycaemic therapies when sacubitril/valsartan is initiated if there is a risk of hypoglycaemia.
Nearly a quarter of those found to have an HbA1c ≥48 mmol/mol (6.5%) at entry to the trial were not known to have diabetes previously, highlighting the ongoing burden of undiagnosed diabetes in those with HFrEF.
The PARADIGM-HF study demonstrated reduced cardiovascular death, hospital admission for heart failure and all-cause mortality compared with enalapril.
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