A meta-analysis, however, failed to show the renoprotective effect of lower HbA1c level achieved by intensive glucose control.39 In addition, we matched cohorts according to aDCSI scores and the use of glucose-lowering medication, including insulin and oral antidiabetic drugs, which may partly reflect glycemic control and lessen the impact of antidiabetic drugs on risk of CKD.40,41 Besides, as other registry-based databases, biochemistry data such as serum creatinine or urinalysis were unavailable in the present database, and therefore different CKD stages were not determined. Here, INS is linked to chronic kidney disease.