The proportions of patients with diabetes who initiated insulin treatment during follow-up was significantly lower in the sacubitril/valsartan group than in the control group (9.3% vs. 12.4%; HR 0.75, 95% CI 0.63–0.89, P = 0.001), and this was not significantly modified by LVEF (Pinteraction = 0.40; Fig. 3). Here, INS is linked to diabetes mellitus.