On the other hand, patients who were initially prescribed a drug other than metformin were more likely to need treatment intensification with a second oral glucose-lowering medication or insulin.[34] Nevertheless, monotherapy with insulin may be indicated for initial treatment for some patients, especially those with impaired renal function.[17] Although our patients limited to monotherapy constituted a small portion of DM population, this study could evaluate the pure effect of different anti-hyperglycemic agents on cardiovascular outcomes. The gene discussed is INS; the disease is diabetes mellitus.