In the 1064 patients with diabetes who used either insulin or sulfonylurea or both at baseline, the same conclusion was drawn but the incidence of first hypoglycemic adverse events was higher (7.8% vs. 4.8%; HR 1.66, 95% CI 1.02–2.71, P = 0.043), whereas in patients with diabetes who used neither insulin nor sulfonylurea at baseline (n = 1331), no significantly increased risk was observed in the sacubitril/valsartan group (1.5% vs. 0.8%; HR 1.92, 95% CI 0.65–5.61, P = 0.24). Here, INS is linked to diabetes mellitus.