I read with great interest the contribution by Yayehd et al. , published online ahead of print on 21 October 2015 in Archives of Cardiovascular Diseases , reporting on 117 patients with Takotsubo syndrome (TTS) from the cohort of “The Observational French SyndromEs of TakoTsubo (OFSETT) study”. Of particular importance, as the authors stated at the outset , is that the patients in this nationwide study are representative of the French population. Also, the study is comprehensive in its scope, with detailed collection of data on all clinical and laboratory aspects of TTS. As is well established in the literature, most of the patients (91.5%) were women, with a mean age for all patients of 71.4 ± 12.1 years. The prevalence of hypertension was 57.9%, and of diabetes mellitus was 11.5%. The low prevalence of diabetes mellitus is in agreement with the findings of a recent report summarizing the previous literature on the association between diabetes and TTS , and with a report based on two Spanish cohorts with 328 patients (90.2% women) with a mean age of 69.7 years, in whom the prevalence of hypertension was 66.8% and the prevalence of diabetes was 13.1% . While the prevalence of hypertension in the French cohort is what one would expect it to be in female patients with a mean age > 70 years residing in Europe, the prevalence of diabetes is less than half of what one would expect . Indeed, for the age group 70–79 years, the average total diabetes prevalence was about one quarter. Impaired glucose regulation prevalence also increased with age, reaching a maximum of 25% in men and 30% in women aged > 70 years . Diabetes appears to be exerting a “protective” effect against the emergence of TTS, probably stemming from the underlying diabetic neuropathy (particularly autonomic neuropathy) acting as a bridle for the unchecked expression of a full autonomic nervous system seethe . According to this hypothetical diabetes/TTS pathophysiological link, patients with severe diabetes experience TTS only when exposed to overwhelming physical or emotional stress, counteracting the diabetes “protective” effect. Thus, patients with mild diabetes or diabetes of short duration are not expected to be “immune” to TTS. Would the authors be kind enough to provide the readers with details of the severity, duration, use of insulin, possible presence of neuropathy and type and extent of the stress that triggered TTS in their 13 patients with diabetes ?