A risk score developed to estimate heart failure outcomes may also capture broader mortality risk in type 2 diabetes mellitus (T2DM). A retrospective observational cohort study, published in Therapeutic Advances in Endocrinology and Metabolism, evaluated the association between the WATCH-DM integer-based score (WATCH-DM(i)) and all-cause mortality in patients with T2DM without known heart failure.

The analysis included 449 adults with T2DM enrolled in a hospital-based outpatient cohort between 2016 and 2022. The WATCH-DM(i) score was calculated using predefined clinical and laboratory variables from the original model. Patients were stratified into four risk categories. All-cause mortality data were obtained through national registry linkage. Prognostic performance was assessed using Cox proportional hazards models, Kaplan-Meier survival curves, landmark analysis, and time-dependent receiver operating characteristic curves.

During a median follow-up of 61 months, 39 patients (8.7%) died. Each 1-point increase in WATCH-DM(i) score was associated with a 29% higher risk of all-cause mortality (HR 1.287, 95% CI 1.151-1.439, p<0.001). Mortality increased across higher risk categories, with greater separation in survival curves observed after 24 months. The model demonstrated good discrimination for 5-year mortality, with a C-index of 0.751.

Metformin use was independently associated with lower mortality risk (HR 0.410, p=0.019). These findings indicate that the WATCH-DM(i) score may serve as a practical tool for mortality risk stratification in outpatient T2DM populations without heart failure.