The lack of a mortality difference between individuals with and without diabetes may potentially have been impacted by changes in practice over the last 10 years when compared to previously published studies, in particular, the consistent application of the left internal thoracic artery in CABG and enhancements to perioperative care: 1) critical care and anesthesia and 2) improved coronary artery disease medical therapy including antiplatelets, statins, and preoperative glucose control and adjustment with standardized guidelines and treatment with insulin and oral antidiabetic drugs. Here, INS is linked to diabetes mellitus.