In conclusion, among patients with HFpEF, those with diabetes taking insulin have more evidence of congestion, worse health‐related quality of life, higher concentrations of NT‐proBNP, and worse clinical outcomes, including higher risks of HF hospitalization, CV death, and all‐cause death, as compared to those not treated with insulin and, particularly, individuals without diabetes. Here, NPPB is linked to hydrops fetalis.