1045-OR: Rates of Cardiovascular Disease and Heart Failure among Diabetes Subtypes Relative to Adults without Diabetes

Introduction and Objective: Subtypes of type 2 diabetes exhibit heterogeneity in rates of atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF) [Li 2026 Diabetologia]. However, whether rates are uniformly elevated relative to matched adults without diabetes is unknown. Methods: Adults (≥40 years) with newly diagnosed type 2 diabetes between 2012-2023 and without history of CVD were 1:2 matched on age, sex, and BMI to those without diabetes in the Epic Cosmos database (n = 1,044,421). Diabetes cases were classified into subtypes using reliable models (AUC: 0.81-0.99): Mild Obesity-Related Diabetes (MOD, 25%), Severe Insulin-Deficient Diabetes (SIDD, 22%), Mild Age-Related Diabetes (MARD, 39%). ASCVD and HF subtypes were identified using billed ICD-10-CM codes. Cause-specific Cox proportional hazards regressions, adjusted for covariates, were used to estimate hazard ratios. Results: Among the analytic sample (64.6 years [SD: 12.5], 52% female, 33.4 kg/m2 [SD: 6.5]), 278,463 were diagnosed with any CVD, 228,065 with ASCVD and 83,556 with heart failure over the duration of follow-up (median: 4 years [range: 1-12]). Although all subtypes had elevated rates of CVD compared with adults without diabetes, SIDD were disproportionately affected (Figure C). Conclusion: Relative to individuals without diabetes and other subtypes, SIDD had the highest rates of ASCVD and HF. These findings highlight opportunities for targeted monitoring of this high risk subgroup.