In contrast to a smaller US-based study, which found no significant association between diabetes subtypes and all-cause mortality and linked only MARD to cardiovascular disease mortality,34 our findings demonstrate that insulin-deficient subtypes (MIDD and SIDD) were associated with markedly higher risks of all-cause and cardiovascular disease mortality, whereas SIRD exhibited only modest associations yet contributed disproportionately to excess years of life-years lost. Here, INS is linked to cardiovascular disorder.