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HbA1c Fell in Diabetics on Sacubitril/Valsartan vs Enalapril in PARADIGM-HF

Of patients in the PARADIGM-HF trial with known or newly diagnosed diabetes, those randomized to sacubitril/valsartan (Entresto, Novartis) showed significant reductions in HbA1c over 3 years compared with those assigned to the ACE inhibitor enalapril, according to a post hoc analysis.

Those taking the newer agent, classified as an angiotensin receptor-neprilysin inhibitor (ARNI), were also less likely to start taking insulin or other meds for glycemic control and showed better improvements in HDL cholesterol.

The significant improvement in HbA1c levels (P=0.0055) over 3 years in the sacubitril/valsartan group vs enalapril implies that heart-failure patients with diabetes who take the drug might benefit from and even require lower doses of any antidiabetic agents they may be taking, according to Dr Jelena P Seferovic (Brigham and Women"s Hospital, Boston, MA).

It"s also justification to update the drug"s labeling for patients with heart failure to include improvement of dysglycemia, she said when presenting the PARADIGM-HF analysis here at the American College of Cardiology (ACC) 2017 Scientific Sessions . Seferovic is lead author on the report published online in Lancet Diabetes & Endocrinology at about the same time.