In a sub-analysis of the Treatment Of Preserved Cardiac function heart failure with an Aldosterone Antagonist (TOPCAT) trial (Pitt et al., 2014), patients from the Americas (n = 1765 patients) were analyzed into 3 subgroups, patients with T2D treated with insulin (ITDM, n = 390 patients), patients with T2D not on insulin (NITDM, n = 406 patients), and patients withoutT2D (n = 969 patients) (Huynh et al., 2019). Here, INS is linked to heart failure.