Lowering blood glucose with insulin in type 2 diabetics reduces microvascular complications but does not reduce cardiovascular mortality, unlike SGLT2 inhibitors.

“when you take a patient with type 2 diabetes you take two patients with type 2 diabetes and you give one of them a lot of insulin and you give the other one not as much insulin one of them is going to have lower blood sugar than the other in the one with lower blood sugar we see less microvascular disease we see that they have fewer amputations less kidney disease lower rates of impotence basically any tiny tiny blood vessel in their body does better when their glucose goes down but if it came down on the heels of insulin going up we don't see a reduction in cardiovascular disease”