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Purpose To assess the incidence of over and underdiagnosis of heart failure (HF) in hospital patients with type 2 diabetes mellitus (T2DM) Methods In the single-center prospective study (registry) from 01.08.2018 to 31.01.2019 we included 1008 patients admitted to the city hospital. Key inclusion criteria: a history of T2DM, age ≥40 years. Key exclusion criteria: any other disorders of carbohydrate metabolism, age Results The presence of HF in the diagnosis at admission was in 68.8% (n=693) of patients and, accordingly, it was absent in 31.2% (n=315). By the ESC HF Guidelines HF was diagnosed in 68.1% (n=686) and, accordingly, in 31.9% (n=322) it was excluded. The analysis results by the diagnosis at admission are presented in Fig. 1. The analysis of the reasons for admission depending on the HF status is presented in Fig. 2. In 35 patients admitted with HF decompensation the presence of HF was not confirmed and the diagnosis was revised: atrial fibrillation in 11 (31,4%) patients, exacerbation of COPD – 7 (20,0%), pulmonary embolism – 6 (17,1%), pneumonia – 4 (11,4%), kidney diseases – 4 (11,4%), and asthma – 3 (8,7%). Conclusion Among hospitalized patients with T2DM, there is a similar incidence of over and underdiagnosis of HF. Patients with first diagnosed HF were more likely to be admitted for reasons unrelated to cardiovascular diseases (CVD), most often with hyperglycemia (Fig. 2). Patients with unconfirmed HF – for reasons related to CVD, while the reason for admission in a quarter of patients was HF decompensation (Fig. 2). Despite the availability of examination for HF, the problem of its diagnosis is still relevant. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2