Turchin A, et al. - In this large, real-world evidence study, researchers explored the connection between decline of insulin therapy by people with type 2 diabetes (T2D) and subsequent blood glucose control. Between 2000 and 2014, they retrospectively studied adults with T2D and suboptimal (HbA_1c ≥ 53 mmol/mol [7.0%]) glycaemic control followed at two academic hospitals who were recommended insulin therapy. Using natural language processing of provider notes, decline of insulin therapy recommendations was identified. Of 5,307 candidates, 2,267 declined insulin therapy. Individuals with uncontrolled T2D subsequently had worse glycaemic control who refused insulin therapy. Such results illustrate the need to enhance the comprehension of the association of this common but poorly explored clinical phenomenon to blood glucose control and eventually diabetes complications.