Aims/hypothesis <p>We examined the incidence of eating disorders (ED) in individuals with type 2 diabetes and their impact on all-cause mortality, composite CVD, cardiovascular (CV)-related mortality and CV-related hospitalisation.</p> Methods <p>This nationwide retrospective cohort study included 1,896,493 adults aged 20 years or older who underwent health examinations between 2013 and 2014. Time-varying Cox analyses were used to evaluate the effects of ED on all-cause mortality, composite CVD, CV-related mortality and CV-related hospitalisation in individuals with type 2 diabetes.</p> Results <p>The type 2 diabetes group demonstrated an increased incidence of ED (adjusted HR [aHR] 1.20 [95% CI 1.12, 1.28]) compared with the general population. Furthermore, the incidence of ED was higher among insulin users (aHR 1.30 [1.09, 1.54]) than among non-insulin users (aHR 1.18 [1.11, 1.27]). The type 2 diabetes with ED group showed an increased rate of all-cause mortality (aHR 2.57 [2.30, 2.87]), composite CVD (aHR 1.68 [1.44, 1.96]), CV-related mortality (aHR 2.68 [1.94, 3.70]), and CV-related hospitalisation (aHR 1.61 [1.37, 1.89]).</p> Conclusions/interpretation <p>Type 2 diabetes mellitus and ED increased all-cause mortality, composite CVD, CV-related mortality and CV-related hospitalisation. ED incidence was higher among insulin users with type 2 diabetes. Therefore, early diagnosis and personalised interventions are crucial to improve outcomes in this high-risk population.</p> Graphical Abstract <p></p>