Background Insulin therapy is a cornerstone in the management of Type 2 Diabetes Mellitus (T2DM), although its relationship with cardiovascular outcomes remains an area of discussion. While it effectively used in managing either types of diabetes, evidence regarding its cardiovascular safety is mixed.

Objective To investigate the association between insulin therapy, timing and duration, and cardiovascular outcomes among adults with T2DM, while accounting for biological, psychological, and social factors, using data from the 2022–2023 Behavioral Risk Factor Surveillance System (BRFSS).

Methods Multivariate logistic regression was used on a de-identified cross-sectional BRFSS data of adults with self-reported T2DM to estimate the association between insulin use and cardiovascular outcomes, while adjusting for age, hypertension, dyslipidemia, smoking status, psychological comorbidities, and medication use.

Results Insulin users exhibited significantly higher rates of coronary heart disease (21.8% vs. 14.2%) and stroke (13.4% vs. 6.6%) compared to non-users (p < 0.001). It was found that early initiation and longer duration of insulin therapy were independently associated with increased cardiovascular risk. These associations persisted after adjusting for biological and psychosocial variables.

Conclusion In this nationally representative sample, insulin therapy, particularly when initiated early or sustained long-term, was associated with higher odds of cardiovascular morbidity in adults with T2DM. These findings highlight the need for individualized treatment approaches that consider both glycemic control and broader biopsychosocial factors.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

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The data that were used in the study are de-identified, publicly available secondary data from BRFSS. Therefore, no ethical approval under institutional or national guidelines is required.

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