The weak signal generated by the insulin–osteomyelitis pair might be explained by insulin exposure as well as the morbidity of diabetes since insulin treatment, indicating a proxy of disease severity or advanced disease stage (Davies et al., 2018; Pasquel et al., 2021), but the morbidity of diabetes might neither be a sufficient condition nor a necessary condition for a patient with diabetes to develop osteomyelitis. Here, INS is linked to diabetes mellitus.