Abstract Body (Do not enter title and authors here): Introduction:
Over 9 million people are estimated to die annually due to Ischemic Heart Disease (IHD). It also serves as an inviolable risk factor for diabetes mellitus type II-related mortality. However, trends in IHD-related mortality tend to show disparities, which if addressed, can improve outcomes.

Research Question:
What are the trends in IHD-associated mortality in individuals with diabetes mellitus type II in the USA?

Goal:
Determining trends stratified by age, gender, race, geographical location, and metropolitan status in IHD-associated mortality in diabetic individuals.

Methodology:
The CDC Wonder database was used to extract crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 population from 1999 to 2020. Annual percentage change (APC) was determined using Joinpoint regression analysis to identify temporal trends.

Results:
The overall AAMR doubled from 1999 (AAMR: 6.61) to 2020 (AAMR: 12.50). It increased from 1999-2005 (APC: 3.67), followed by a decrease during 2005-2014 (APC: -1.09), and finally a steep incline till 2020; 2014-2018 (APC: 5.53) and 2018-2020 (APC: 12.70). Men had a higher AAMR than women, 11.57 versus 6.19. Older adults aged 85+ had the highest CMR (137). NH American Indians or Alaska Natives had the highest AAMR (12.01), followed by Hispanic or Latino (9.73), NH Black or African American (8.81), NH White (8.44), and NH Asian or Pacific Islander (6.69) populations. Stratified by census regions, the highest death rate was in the Midwestern region (AAMR: 10.07), followed by the Western, Southern, and Northeastern regions; AAMR: 9.74, 7.81, and 6.29, respectively. Among the states, West Virginia had the highest AAMR of 16.61, while Nevada had the lowest AAMR of 3.47. Non-metropolitan areas consistently showed higher rates (AAMR: 10.87).

Conclusions:
Rising trends were observed in IHD-related fatalities in type ll diabetes patients between 1999 and 2020. Amongst various groups, the highest AAMRs were found in those over 85 years, men, American Indians or Alaska Natives, and residents of the Midwest, West Virginia, and non-metropolitan areas. These findings can aid in developing targeted interventions and strategies to counter the alarming rise in mortality rates.