From 1988-1994 to 2013-2020, there was no significant change in the proportion of adults using insulin who achieved glycemic control (HbA1c level <7%) (29.2% [95% CI, 22.6%-36.8%] to 27.5% [95% CI, 21.7%-34.2%]; P = .87 for trend) or had severe hyperglycemia (HbA1c level >10%) (18.2% [95% CI, 13.0%–24.8%] to 14.6% [95% CI, 12.0%-17.5%]; P = .28 for trend) (Figure 1). Here, INS is linked to Hyperglycemia.