This nationwide cohort study in Taiwan demonstrated that, among patients with type 2 diabetes receiving insulin therapy, the addition of GLP-1 RAs was associated with reduced risks of MACE, hospitalizations for stroke, coronary artery disease, and heart failure, as well as major microvascular complications, end-stage kidney disease, sight-threatening retinopathy, leg amputation, and all-cause mortality, compared with the addition of DPP-4 inhibitors or sulfonylureas. Here, GLP1R is linked to heart failure.