INS and congestive heart failure: Karter et al., in a cohort study, add a different perspective based on timeframe to this discussion by elucidating that when short-term pioglitazone use was compared to the conventional, first-line diabetes treatment such as sulphonylureas, metformin, and insulin, there was no evidence of a higher risk of congestive heart failure hospitalization (HR = 1.28; 95%CI 0.85-1.92) [35].