Variables for the multivariable adjustment included age, sex, ethnicity, country district, socioeconomic status, obesity, hypertension, hyperlipidemia, active smoking, hemoglobin level, total cholesterol, high-density and low-density lipoprotein cholesterol, triglycerides, eGFR, diabetes duration (years), insulin therapy, diabetic microvascular complications (neuropathy, nephropathy, or retinopathy), chronic obstructive pulmonary disease, chronic kidney disease, prior stroke, peripheral artery disease, active malignancy, ischemic heart disease and chronic heart failure. This evidence concerns the gene INS and chronic obstructive pulmonary disease.