Abstract Body (Do not enter title and authors here): Introduction:
Diabetes mellitus type 2 (T2DM) is an established risk factor for acute myocardial infarction (AMI). Current data suggests that mortality risk of AMI in diabetics remains significantly higher than non-diabetics. Therefore, we aim to examine the trends in AMI-related deaths among younger and older diabetic adults in the United States from 1999 to 2020.

Methods:
We used CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access mortality data from 1999 to 2020. AMI and T2DM-related deaths, age ≥ 35 years, were identified from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 1,000,000 population using ICD codes for AMI including (I21.0-I21.9, I22.0-I22.1, I22.8-I22.9) and T2DM (E11.0-E11.9). Joinpoint regression was used to examine trends and annual percentage change (APC) overall and stratified by sex, race, and rural-urban distribution.

Results:
Between 1999-2020, 164,260 individuals died from AMI and T2DM with an overall AAMR of 43.2 (95% CI: 43, 43.4). AAMRs related to AMI and T2DM modestly increased from 42 in 1999 to 46.8 in 2005 (APC 2.84, 95% CI: 0.1, 8.43), followed by a significant decline to 38.8 in 2014 (APC -1.95, 95% CI: -4.17, -1.29), with subsequent significant increment to 52.2 in 2020 (APC 4.26, 95% CI: 2.73, 6.90). Men had higher AAMRs when compared to women (AAMRs men: 57.2; women: 32.5). After an initial rise from 1999-2003 in men and 1999-2005 in women, AAMRs declined in both men and women till 2014 (AAMRs men: 52; women: 28.3), followed by a significant rise till 2020 (AAMRs men: 71.5; women: 36.3). Among the race groups, AAMR was highest in American Indian or Alaska Natives (75.8), followed by Hispanics (56.4), Non-Hispanic (NH) Blacks (54.5), NH Whites (NHWs) (40.8), and lastly Asian or Pacific Islanders (38.2). According to the rural-urban classification, non-metropolitan areas demonstrated higher AAMRs than metropolitan areas (AAMRs: non metropolitan: 57.2; metropolitan: 40.3).

Conclusion:
Lesser urbanization, men, and American Indian or Alaska Natives are associated with higher mortality rates. Further in-depth research is needed to comprehend the underlying mechanisms interlinking AMI and T2DM and provide tailored interventions for mortality reduction among patients with concomitant AMI and T2DM.