INS and hydrops fetalis: Clinical trials showed that drugs that potentiated insulin signaling such as sulfonylureas, thiazolidinediones, and incretins were associated with an augmented risk of HF development or worsening of the preexisting HF, while antidiabetic drugs that counter hyperglycemia through non-insulin pathways such as metformin and sodium-glucose cotransporter 2 inhibitors (SGLT-2 inhibitors) decreased the risk of HF development (Nassif and Kosiborod, 2018; Packer, 2018d).