On Cox multivariable analysis, T2DM patients prescribed insulin had a 3-fold increase in the risk of primary composite outcome compared with non-DM patients (HR = 3.11; 95% CI, 1.45–6.87; P = 0.009), whereas T2DM patients not prescribed insulin had a 2-fold increase (HR = 2.16; 95% CI, 1.06–4.40; P = 0.015) after adjustment for baseline characteristics, etiology of HF, NT-proBNP, eGFR, and utility of sacubitril/valsartan. This evidence concerns the gene INS and hydrops fetalis.