This apparent paradox may be explained by the lower prevalence of atrial fibrillation in patients treated with insulin, which itself is an interesting finding that has been highlighted recently.21 Tan and colleagues suggested that differences in cardiac remodelling might explain the relative ‘protection’ HFpEF patients with diabetes have against atrial fibrillation, although our data suggest that this difference is confined to patients treated with insulin. Here, INS is linked to atrial fibrillation.