In the absence of such a trial, it may be preferable to avoid insulin, if possible, especially as there is some evidence that an alternative class of glucose‐lowering agents, the SGLT2 inhibitors, may be safe in HF.7, 8, 9, 10 However, prospective randomized outcome trials with these drugs in patients with established HF are required and are now underway.29 This evidence concerns the gene INS and hydrops fetalis.