Min JY, Hackstadt AJ, Griffin MR, et al. - Researchers conducted this investigation to assess if the link between insulin use and death was mediated by weight change or hypoglycemia. Change in BMI and hypoglycemia were assessed during the first 12 months of treatment intensification in a retrospective cohort of veterans who filled a new prescription for metformin and added insulin or sulfonylurea (2001-2012). Of the 28,892 patients who survived 12 months, insulin users had 15.4 deaths per 1,000 person-years and sulfonylurea users had 12.9 deaths. Of the 30,214 patients surviving 6 months, insulin users had 34.8 deaths per 1,000 person-years and users of sulfonylurea had 21.3 deaths. According to findings, a higher risk of death was found among metformin users intensifying treatment with insulin vs sulfonylurea and surviving 6 months of intensified therapy, but not among those surviving 12 months. This connection was mediated partly by weight change.