Real-world experience of angiotensin receptor neprilysin inhibitor on the glucose-lowering effect

We investigated the effect of angiotensin receptor neprilysin inhibitor (ARNI) on glycemic control in Korean patients. This retrospective cohort study was conducted at a single tertiary hospital. We compared the HbA(1c) level reduction between the ARNI and angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) in chronic heart failure patients with diabetes. We also examined whether the target HbA(1c) level was reached and the time to start insulin between the two groups. Over the study period, ARNI did not significantly lower the HbA(1c) level after adjusting confounding factors compared to ACEIs or ARBs. However, as a result of a simple comparison using Mann-Whitney U test, ARNI group showed significant decrease in HbA(1c) at 6, 12, and 24 months compared to ACEIs or ARBs group (p = 0.003, 0.009, and 0.026, respectively). The initiation of insulin was delayed in the ARNI group, but this difference was not significant based on the result of hazard ratio, but cumulative incidence was significantly lower in the ARNI group. In the real world, the blood glucose-control effects of ARNI were not superior to those of ACEIs or ARBs. However, long-term studies are needed as ARNI use increases to obtain more statistically significant results.