Angiotensin receptor-neprilysin inhibitor reduces HbA1c levels
New analysis shows Novartis Entresto improves glycemic control in reduced ejection fraction heart failure patients with diabetes
Presented at ACC.17 by Jelena SeferovicNews - Mar. 21, 2017
- After 1 year, HbA1c levels were decreased by 0.26% when using sacubitril/valsartan, compared to 0.16% when using enalapril (P=0.0023).
- No significant relationship between change in HbA1c and the composite primary outcome of cardiovascular death or first hospital admission for HF in the entire cohort of patients with diabetes (HR 0.99, 95% CI 0.91–1.06, P=0.70) was observed.
- After 3 years, overall HbA1c levels were reduced with 0.14% with sacubitril/valsartan, compared to enalapril (95% CI 0.06-0.23, P=0.0055).
- Insulin therapy was initiated during the study in 29% fewer patients on sacubitril/valsartan compared to enalapril (HR 0.71, 95% CI 0.56-0.90, P=0.0052).
- Also fewer patients started oral antihyperglycaemic therapy (HR 0.77, 95% CI 0.58–1.02, P=0.073) in the sacubitril/valsartan group, however the difference did not reach statistical significance.
Treatment of HFrEF diabetes patients with sacubitril/valsartan was associated with greater reductions in HbA1c compared with enalapril treatment. Moreover, fewer sacubitril/valsartan-treated patients needed initiation of insulin therapy. These data suggest that, in addition to providing HF benefit, sacubitril/valsartan helps to tighten glycemic control among HF patients with diabetes. This beneficial metabolic effect is most likely secondary to the inhibition of neprilysin and consequent modulation of its circulating substrates and should be further investigated.
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