Several previous large observational studies have examined risks of cardiovascular events associated with the overall SGLT-2i class compared to other glucose lowering drug users (metformin, sulphonylurea, thiazolidinedione, glucagon-like peptide-1 [GLP-1] receptor agonist and insulin) and DPP-4i users [7–10, 13], however, effect modification by history of CVD or HF was not examined. This evidence concerns the gene GCG and hydrops fetalis.