The current study demonstrated that (i) being underweight was associated with a 2.4-fold increased risk of SCD in DM patients; (ii) DM patients who were pre-obese (25 ≤ BMI < 30), and more specifically, 27 ≤ BMI < 28 showed the lowest risk of SCD; (iii) a stronger association between being underweight and the risk of SCD was observed in middle-aged people (40–65), heavy-drinkers, and those without dyslipidemia and insulin therapy. Here, INS is linked to diabetes mellitus.