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. The gene discussed is INS; the disease is congestive heart failure.