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. Disclosure J. Varghese: None. J. Guo: None. R. Ekanayake: None. D. Hua: None. T. Hung: None. Z. Li: None.