Background: Heart failure with preserved ejection fraction (HFpEF) represents a significant unmet medical need and is associated with poor outcomes. Registry evidence suggests a mortality-rate of 40.8% at 3 years, in Indian patients with HFpEF. Timely diagnosis of HFpEF in patients with predisposing factors and indicators, is essential in improving care. Aim: The clinical profile of patients with HFpEF, is known to be different in South-Asian patients, as compared to other Asian or global population. This is a real-world analysis of patients with T2DM and co-existing HFpEF, in the Indian diabetes outpatient-setting. Method: A cross-sectional analysis of patient-records was performed across 3 diabetes outpatient departments across the cities of Kolkata and Mumbai, in India. Records of patients with T2DM and HFpEF, as defined in the recent guidelines were included for analysis. Clinical characteristics of patients were descriptively analyzed. For categorical variables, unpaired t-test was used, whereas for non-parametric variables, odds ratio was estimated. Results: Records of 99 patients with HFpEF and T2DM, were available for analysis. The age ranged from 45 to 87 years, with average age being 66.3 (SD 9.3) years. 22% of patients were aged <60 years. 48% of patients were females. Of the 97 patients with available information for duration of diabetes, the average duration was 14.1 (SD 7.6) years. 26% patients had T2DM of <10 years’ duration. The average BMI was 26.7 (SD 4.8) kg/m2. 57% of patients were obese. 34% of females and 50% of males had a history of IHD. History of atrial fibrillation was present in 9% of patients. The average age of patients with and without A-Fib was 72.7 (SD 6.0) years, and 65.7 (SD 9.4) years, respectively; the difference in mean was significant (p = 0.034). Mean SBP was 140.5 (SD 19.0) mmHg. SBP level of ≥130 mmHg was observed in 76% of patients, and ≥140 mmHg was observed in 53.5% of patients. The average NT-proBNP LEVEL was 1235.4 pg/mL. The NT-proBNP levels ranged from 51 to 23000 pg/mL. 44 (47%) had eGFR level <60 mL/min/1.73m2. Average HbA1c level was 8.1% (SD 1.95%). 78% of patients had LDL-c level <100 mg/dL, whereas 46% had LDL-c level <70 mg/dL. Discussion: The analysis represents clinical characteristics of patients with HFpEF, in the clinical setting of T2DM in India. Despite HFpEF being strongly associated with old age, we observed at-least 1 in 5 patients to be <60 years old. Of note, 43% of patients with HFpEF were not obese. Blood-pressure control remained inadequate, despite good control of HbA1c and LDL-cholesterol levels. It is essential to suspect and screen for underlying HFpEF in patients having these comorbidities with T2DM, and to aggressively manage the risk-factors, keeping in mind the possible inconsistencies like younger-age or lower BMI in substantial number of patients.