1. Clarity on Observational Studies (OS) and Potential Bias
   It is unclear where these three observational studies (OS1, OS2, and OS3) originated from.

The authors should provide detailed references or registration information for each of the studies to clarify their sources.

Additionally, the time gaps between the studies are substantial and raise questions about the consistency and comparability of the datasets.

The authors need to carefully explain the rationale behind these gaps and how they addressed potential selection biases that could result from differences in patient populations and study periods.

1. Robustness of the Methods Section and Diagnosis Determination
   The methods section lacks sufficient detail regarding how diagnoses were determined.

Although the results section briefly mentions that the diagnosis followed ADA criteria, a clear explanation in the methods section is necessary.

The methodology should provide a thorough description of how diabetes diagnoses were confirmed and any diagnostic procedures employed, which is vital for ensuring the study’s robustness and reproducibility.

1. Strength of the Study Not Reflected in the Discussion
   The discussion section does not adequately reflect the strengths and unique contributions of the study.

It repeatedly focuses on the use of SGLT2 inhibitors, without giving sufficient attention to other key findings, such as the shifts in drug usage patterns and the increase in the proportion of patients achieving HbA1c targets over time.

The discussion should be expanded to highlight the broader clinical implications and contributions of this study to the field of diabetes management, particularly in high cardiovascular risk patients.

1. Clinical Implication of the Study
   The clinical implications of the study remain unclear. The authors should explicitly state the real-world impact of the findings on clinical practice.

For example, how do the shifts in medication use and the increase in HbA1c control affect long-term cardiovascular outcomes in high-risk patients? A clearer statement regarding the clinical takeaways would strengthen the value of the study.

1. Paragraph Structure and Logical Flow
   The current organization of the manuscript is difficult to follow, and the logic within the paragraphs needs to be restructured.

The transitions between sections and within paragraphs are abrupt, making it challenging for readers to understand the narrative.

A more logical flow of ideas, starting from the study rationale, methodology, and key findings, followed by a cohesive discussion, would improve readability and comprehension.

The manuscript is well-written and offers significant insights into the evolution of T2DM treatment in patients with high cardiovascular risk.

The longitudinal approach provides a valuable perspective on treatment trends.

Addressing the above-mentioned concerns would strengthen the manuscript further and enhance its contribution to the field.

1. Comparability of the Three OS:
   Since the treatment protocols and clinical practices have evolved significantly over the years, especially with a higher prevalence of prior PCI in OS3 and the long interval between OS3 and the earlier studies, it is important to ensure that the three observational studies are truly comparable.

The Methods section should explicitly state whether all three cohorts used the same diagnostic criteria for T2DM, as mentioned ADA 2019 guidelines?, to confirm that the diagnostic consistency was maintained throughout. Clarification is needed to address potential confounding factors introduced by the changes in treatment approaches over time.

1. Discontinuation of Metformin Before Coronary Angiography:
   The manuscript does not adequately describe how the process of discontinuing metformin before coronary angiography was handled in the dataset and the analysis. Given that metformin is widely used and could impact outcomes if discontinued prior to angiography, more details on how this aspect was managed should be provided.

Were there specific criteria for discontinuation, and how was this information captured in the data? If not addressed, this could introduce a potential bias in the analysis.

1. Clinical Implications of the Results:
   While the results are well-presented, the discussion on the clinical implications is somewhat limited. A more thorough summation of what these findings mean for clinical practice would enhance the impact of the manuscript.

For example, the shift from metformin to SGLT2 inhibitors as the most commonly used class of glucose-lowering drugs in OS3 should be discussed in the context of guideline changes and emerging evidence for cardiovascular benefits of SGLT2 inhibitors.

The implications of the increasing complexity of combination therapies should also be elaborated, particularly regarding patient adherence, cost-effectiveness, and individualized treatment strategies.