Abstract Body: Diabetes Mellitus (DM) is closely associated cardiovascular events and adversely effects the cardiac structure and function. Although persons from African ancestry are at high risk of diabetes-related cardiac abnormalities, little is known about diabetes associated echocardiographic abnormalities in Tobago at the population level. Therefore, the aim of this study was to investigate the association between DM and abnormal cardiac structure and function among African Caribbeans in Tobago. A total of 926 participants without history of heart failure underwent clinical examination and transthoracic echocardiography (TTE) from 2021 to 2024 in the Tobago Health Study (a community-based longitudinal cohort study of adults aged 40+ years). Echocardiographic images were captured using standard 2-D, M-mode doppler TTE conducted at a local cardiology clinic. Images were analyzed for left ventricular (LV) ejection fraction, left ventricular mass index (LVMI), left atrium mass index, diastolic dysfunction (DD), LV structural abnormalities (normal, concentric remodeling, and left ventricular hypertrophy [LVH]), E/e’ ratio, E/A ratio, and others by a centralized reading laboratory. Multivariable linear or logistic regressions were used, where age, sex, systolic blood pressure, body mass index (BMI), smoking status, and sedentary behavior which was assessed by TV watching were adjusted in each model. The mean age of this cohort was 60.8 with 61.2% female, 47.7% obesity (BMI >30 kg/m²) and 20.2% self-reported DM. Most of the participants (77.2%) had LV structural abnormalities, predominantly concentric remodeling (69.5%). Additionally, the prevalence of DD was 13.4%, and LV ejection fraction <50% was 1.5%. The results of the multivariable regression analysis showed that self-reported DM is significantly associated with E/e’ ratio (p<0.001, Table) and LVMI (p=0.002, Table). In addition, in a subset of participants with fasting serum glucose (FSG, N=667), DM status was defined by FSG >125 mg/dL, oral diabetes medications, and/or use of insulin. DM based on FSG identified additional participants with undiagnosed DM but showed similar association with echocardiography metrics as those based on self-reported DM status. In conclusion, African Caribbean adults in Tobago with DM are at higher risk of abnormal LV structure and LV diastolic dysfunction. Thus, these results highlight the importance of DM awareness and control for optimal cardiac structure and function in Tobago.