However, given the difficulties in controlling the complex influences on lipid metabolism of insulin, insulin-releasing stimulants, and other concomitant multiple medications used for DM patients in clinical practice and in defining appropriate thresholds of duration and level of lipid abnormality for AP risk, we believe that it would be impossible to estimate the AP risk with hypertriglyceridemia alone in our observational study. This evidence concerns the gene INS and alkaline phosphatase measurement.