Neyer et al present a series of observational studies that together paint a picture of glucose-lowering therapy use in patients that have undergone coronary angiography (and are therefore at high cardiovascular risk) over the course of three decades in a single hospital in Austria.

The long time-span covered in the analysis is of real interest, as is the insight on how medication usage has (or has not) shifted following changes in guidelines for evidence-based treatment of diabetes and cardiovascular disease.

Overall, the narrative is presented in a clear and straightforward manner. It is encouraging to see increasing use of SGLT2i and decreasing use of SUs reflected in the studies.

The low utilization of incretin mimetics through 2023 is notable, though the higher fraction of patients reaching HbA1c targeting the most recent cohort is encouraging.

A few minor comments:

• It would be nice to comment in the text on some of the changes in patient population across studies (Table 1 & Table S1).

For instance, history of PCI was notably higher in OS3 (39.7%) than OS1 and OS2 (11.2 and 16.2%). Any hypotheses on why? LDL-C and total cholesterol were also lowest in OS3.

• In the Discussion, it would be helpful to discuss relevant changes in national healthcare reimbursement or treatment guidelines that may put the observations in context. How does the situation in Austria compare to other countries over time?

Specifically, any changes in the use of coronary angiography over time that would have impacted the type of patients enrolled in OS1-OS3?

• Line 186: note that SGLT2i are approved for HF, so this makes sense.