For the occurrence of a HF-related hospitalization within 5 years, there were no significant differences between the sulfonylureas and insulin groups (risk difference 0.057, 95% CI -0.011 to 0.132; P=.11), and between the GLP1 RA and DPP4i groups (risk difference 0.010, 95% CI -0.096 to 0.129).<h4>Conclusions</h4>We evaluated real-world evidence on 2 head-to-head comparisons of second-line T2D therapies on 5-year HF outcomes. Here, INS is linked to type 2 diabetes mellitus.