Intro: Diabetes (DM) and heart failure (HF) are an epidemic. Randomized controlled trials demonstrated sodium glucose cotransporter 2 inhibitors (SGLT2i) are beneficial in these patients. Guidelines suggest SGLT2i, such as empagliflozin, as potential first line therapy. We sought to determine utilization patterns and compliance to empagliflozin. Methods: We assessed utilization and compliance in patients with DM and HF from the Veterans Affairs national database from 2015-2022. Initiation was calculated as the number of new empagliflozin prescriptions per 1,000 eligible patients. Compliance was calculated using the proportion of days covered (PDC). Compliance to empagliflozin was defined as PDC > 80%. Results: A total of 44,608 patients exposed to empagliflozin were included. The majority of patients are white (n=33,663; 75.5%) male (n=43,335; 97.1%). A total of 6.6% were Hispanic or Latino (n=2,955). Table 1 shows incident empagliflozin prescription by year. The average proportion of days covered (PDC) was 0.83 (SD 0.21). The proportion of empagliflozin compliant patients was 66.2%. Conclusions: Empagliflozin prescriptions have increased exponentially since 2015. Compliance to empagliflozin was moderate necessitating a potential intervention to increase compliance. Disclosure C.A.Alvarez: Research Support; Boehringer Ingelheim Inc. A.Perkins: None. M.A.Sigler: None. H.Yang: None. H.Caberwal: Employee; Boehringer Ingelheim Inc. R.Ebrahimi: Consultant; Pfizer Inc., Speaker's Bureau; Novo Nordisk. Funding Boehringer Ingelheim