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New heart failure drug may ‘improve glycaemic control in type 2 diabetes’

A new heart failure drug hailed as ‘game-changing’ by GP experts may improve glycaemic control in heart failure patients with type 2 diabetes, authors of a subgroup analysis of trial data claim.

Patients receiving the drug, a sacubitril/valsartan combination that was recently approved for use in the NHS, had consistently lower Hb1Ac levels than those receiving enalapril and were less likely to start insulin treatment during follow-up, their analysis found.

The subanalysis included just under 3,800 patients from the PARADIGM-HF trial – the main findings of which Pulse reported on two years ago – who had systolic heart failure and either known diabetes or raised HbA1c levels of 6.5% or above.

The subanalysis – published in the Lancet Diabetes and Endocrinology – showed that HbA1c levels were significantly greater in the sacubitril/valsartan group after one year, with a 0.26% HbA1c reduction compared to 0.16% in the enalapril group.

Those taking the new drug also had a 29% decrease in the rate of new use of insulin over the three-year follow up.

‘These data suggest that in addition to the heart failure benefits previously shown, sacubitril/valsartan might have favourable metabolic effects in patients with heart failure and diabetes,’ the authors wrote.

‘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 HbA1c concentrations decrease.’

NICE has recommended use of the sacubitril/valsartan combination drug for heart failure patients, but only as a second-line option that should be initiated by specialists.

The recommendation came after the original trial showed it reduced hospitalisation for heart failure and mortality compared with treatment with enalapril, leading some GP experts to label the drug a ‘game changer’ that could end up replacing treatment with established generic ACE inhibitors and ARBs.

Experts commented in a linked editorial that the findings were ‘important’, given that a number of antidiabetic drugs have been linked to worsening heart failure, and ‘several heart failure therapies… might aggravate dysglycaemia’.

‘Thus, any heart failure therapy that is protective against incident diabetes or worsening glycaemic control is a welcome addition,’ wrote cardiologists Dr Gregory Giamouzis, from the University of Thessaly, Greece, and Dr Javed Butler, Stony Brook University, New York.

Lancet Diabetes Endocrinol 2017; available online 18 March



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