INS and diabetes mellitus: While we attempted to adjust for these differences in our multivariable analyses, unmeasured confounders could not be accounted for.30 In one large placebo‐controlled trial in patients with pre‐diabetes and established type 2 diabetes, insulin did not increase the risk of incident or recurrent HF hospitalizations, although patients in NYHA class III or IV were not enrolled in this trial and the prevalence of HF at baseline was not recorded.31, 32