Reason may be because of the fact that with time, diabetes progressed and became less responsive to treatment.8 Moreover, use of many medications may decrease patient compliance to therapy,9 which led to loss of glycemic control10 and resultant increase in DFU risk.11 An additional explanation could be that when patients started insulin, they may already had diabetes for a longer duration, with greater associated complications already present. The gene discussed is INS; the disease is diabetes mellitus.